Governor Newsom signed over 1,300 bills and vetoed approximately 190 bills in 2024. Similar to previous years, in 2024 California enacted several laws that will significantly impact the healthcare industry. From artificial intelligence (AI) to healthcare providers and health plans, these new laws require active efforts to ensure ongoing compliance.
We highlight below the most important health care-focused bills passed this year. Unless otherwise stated, these new laws will take effect on January 1, 2025.
Notably, some of the bills that were vetoed were: AB-3129 As discussed here, this would give the California Attorney General the power to review the health care transactions of certain private equity groups and hedge funds. Similarly, SB-966 The bill, which was vetoed, would have established, for the first time, licensing, oversight and reporting mechanisms for pharmacy benefit managers. Finally, from an enforcement perspective, the California Department of Managed Care has issued an unusual rule. Are you okay Failure to license a health care service plan by a behavioral health company that provides employee assistance program services.
artificial intelligence
AB-3030: Artificial intelligence in patient communication
AB-3030 requires disclaimers to be provided for AI-generated patient communications that contain clinical information (i.e., not just scheduling, billing, administrative, or similar information). The waiver must specify that the communication was created using generative AI and provide explicit instructions explaining how the patient can contact a human health care provider or other appropriate person. must be provided. This law applies to all medical facilities, clinics, clinics, and communications, both written and oral, with patients, including clinical information.
Additionally, AB-3030 applies to each generative AI communication that includes clinical information, regardless of whether the patient has previously received such generative AI communication. Importantly, a disclaimer is not required if the generated AI communication is read and reviewed by a licensed or certified healthcare provider before distribution to patients.
SB-1120: Artificial intelligence in pre-approval
SB-1120 prohibits entities from using (or using) AI-enabled, algorithmic, or other software tools for usage review (UR) or usage management (UM) to ensure compliance with certain requirements. You need a complete and professional medical service plan and disability insurance company. . This includes software tools that assess medical necessity, in whole or in part, in conjunction with prospective, retrospective, or concurrent UR/UM review capabilities. Health plans and disability insurance companies rely on AI-enabled, algorithmic, or other software tools to determine medical necessity based on clinical information or other specified information applied fairly and equitably. Written policies and procedures must be implemented and disclosed to requesting health care providers to ensure that the
Importantly, such tools are prohibited from determining ultimate medical necessity to delay, deny, or modify treatment. Only a licensed health care professional qualified to evaluate the specific clinical issues involved will review (1) the requesting provider’s recommendation, (2) the enrollee’s medical or other clinical history, and (3) You are empowered to assess these medical needs by considering your individual clinical situation.
Healthcare facility/provider
AB-2107: Remote review of clinical tests
In accordance with the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and California law, clinical testing (including review and reporting of laboratory test results) must be performed at a licensed clinical laboratory. AB-2017 allows California laboratories to remotely review and report “digital materials” if CLIA requirements are met, including that the remote location must be under the primary site’s CLIA certification . “Digital materials” are defined as digital laboratory data, digital results, and digital images that do not require a separate laboratory-required microscope or other equipment.
Importantly, the California Department of Public Health, in consultation with the Centers for Medicaid and Medicaid Services, must assess whether such remote screenings are CLIA compliant by June 20, 2025 . The parties have until January 1, 2026 to make a final decision.
AB-2297: Charity care from hospitals and emergency physicians
Under California’s current law, emergency physicians can choose whether to qualify patients with incomes up to 350% of the federal poverty level for discounted payment policies. AB-2297 adjusts this limit up to 400% of the federal poverty level. Additionally, the law clarifies that out-of-pocket “high-cost medical expenses” mean medical expenses that are not reimbursed by insurance or a health care program such as Medicare or Medi-Cal cost-sharing.
AB-2297 also eliminates the authority for hospitals to consider financial assets in determining eligibility for both charity care and discounted payment policies, but does not allow hospitals to consider a patient’s or family’s health savings account. There is. Additionally, neither the hospital nor the emergency physician may use a lien on real property as a means to collect unpaid hospital or emergency physician fees owed by the patient. Finally, hospitals and emergency physicians may (1) require patients to apply for Medicare, Medi-Cal, or other insurance prior to reviewing/providing discounted payments or (2) based on the timing of a patient’s application. You may not be denied eligibility.
AB-2319: Mandatory maternal and child health training
Current California law requires hospitals and clinics that provide perinatal care to provide implicit bias training to certain types of health care providers twice a year. AB-2319 expands the list of health care providers required to complete implicit bias training and provides perinatal care, perinatal care, primary care and outpatient clinics under Part 2 of the California Business and Professions Code. Include all licensed health care providers regularly assigned to provide alternative births. centers, emergency departments, etc. Additionally, those who work regulatoryly with perinatal patients, including those who facilitate or coordinate access to care, must complete such training.
Per AB-2319, all training must be completed by June 1, 2025, or within six months of date of hire for new hires. Hospitals will be required to annually submit a Certificate of Compliance to the California Attorney General by February 1, 2026, including an explicit classification and summary of the types of employees determined not to receive implicit bias training. There is.
SB-1061: Consumer Medical Debt Reporting
SB-1061 prohibits hospitals and other health care providers from providing medical debt information to consumer credit reporting agencies (CRAs). The expression “medical debt” includes unpaid and paid medical bills, but expressly excludes medical debt related to cosmetic surgery. Additionally, if a hospital or other insured health care provider knowingly provides a consumer’s medical debt information to the CRA, the underlying medical debt becomes void and unenforceable.
Additionally, SB-1061 requires health plans to send notifications to both the insured and the provider when insurance payments are sent directly to the insured. If the provider does not receive payment from the insured within 30 days of notification or within one year of the initial claim, the amount owed to the provider may be reported to the CRA as a medical debt. Finally, hospitals and covered health care providers must maintain a list of all debt collectors to whom medical debt claims are sold or assigned, and any such collectors must be aware of any lawsuits arising from the underlying debt. must be reported.
SB-1300: Publication and hearing before closing a maternity or psychiatric ward
Under current law, health care facilities are required to give public notice 90 days in advance of any proposed closure or elimination of a maternity or psychiatric ward. SB-1300 extends the required notice period before closing a maternity or psychiatric ward from 90 days to 120 days. Pursuant to SB-1300, a health care facility must hold at least one public hearing and accept public comment within 60 days of publicizing a proposed closure of a maternity or psychiatric ward. In addition, the health care facility must notify the board of supervisors of the county in which the health care facility is located and request testimony from the board regarding the impact of the closure on the county and local health care system.
health plan
AB-3275: Shorten the time it takes to get your plan bill refunded
AB-3275 reduces the time period for a health care service plan, including a Medi-Cal managed care plan, or health insurance company to reimburse a completed clean claim, or a portion thereof, from 45 calendar days to 30 calendar days after receipt of the claim. I will. If a claim is incomplete, the health care service plan or insurance company must notify the claimant no later than 30 calendar days after the date the claim is challenged or denied. Additionally, the legislation increases the daily penalty for late claims to the greater of $15 or 10% of the unpaid interest.
