Overview
The state of California is a national leader in healthcare price and competition initiatives and continues to make strides in healthcare system reform. In price transparency, California’s repeated efforts to establish an all-payer claims database came to fruition with the passage of AB 1810 in 2018, after a long road of legislative efforts spanning over ten years. With a one-time $60 million appropriation to California’s Office of Statewide Health Planning and Development (“OSHPD”), AB 1810 mandates the creation of Health Care Cost Transparency Database by July 2023. California also has robust legislative protections against surprise and balance billing, prohibiting out-of-network provider “surprise bills” for both emergency and non-emergency services.
California also leads the nation on the drug price transparency front with SB 17, a landmark law that requires drug companies to give advanced notice of prescription drug price increases to public and private purchasers of health care and health care coverage. Despite legal challenges to the law, it is seen as a meaningful step to negotiate the political and legal boundaries of state action to rein in drug prices.
In healthcare market competition, the state is active in antitrust enforcement of provider anticompetitive practices, most notably in the historic action against Sutter Health, in which the California attorney general sued the Northern California hospital giant for leveraging its dominant market power to demand all-or-nothing, anti-tiering and anti-steering, and gag clauses in its contracts with insurers. As an extension from the case, the legislature continues to seek increased merger review authority of health care entities as well as legislative prohibition of anticompetitive terms in provider contracts, most recently with the introduction of SB 977 in the 2020 session.
Overall, California remains an active participant in the initiative to reduce healthcare costs and improve price transparency. The state legislature has also explored healthcare market initiatives including a single payer system (SB 562) as well as state public option (AB 2472). California’s legislation and regulation aligns with similarly active and progressive states by focusing on pharmaceutical costs and stakeholder transparency measures. For more information and the latest updates, follow the California Legislative Beat on The Source Blog.
See below for an overview of existing California state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 12/5/2022 - 9/8/2023 (2023-2024 term). *Current session bill updates are ongoing. Check back weekly for updates.
AB 0991 – California
Introduced: 2019 Status: Enacted
The board may refuse to issue any registration or license, or may suspend or revoke the registration or license of any associate or licensed professional clinical counselor, if the applicant, licensee, or registrant has been …
AB 1011 – California
Introduced: 2021 Status: Inactive / Dead
Health care coverage: substance use disorders. 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 …
AB 1014 – California
Introduced: 2019 Status: Inactive / Dead
The Governor VETOED this bill. Health facilities: notices – This bill would require a hospital that provides emergency medical services to provide notice, as specified, at least 180 days before a planned reduction or elimination …
AB 1020 – California
Introduced: 2021 Status: Enacted
Health care debt and fair billing. Existing law requires a hospital to maintain an understandable written policy regarding discount payments for financially qualified patients and an understandable written charity care policy. Existing law requires that …
AB 1022 – California
Introduced: 2023 Status: In Process
Medi-Cal: Program of All-Inclusive Care for the Elderly. Existing federal law establishes the Program of All-Inclusive Care for the Elderly (PACE), which provides specified services for older individuals at a PACE center so that they …
Cal. Ins. Code § 10123.855. Telehealth services; requirements for health insurance contracts – California
Introduced: Status: Enacted
A contract issued, amended, or renewed on or after January 1, 2021, between a health insurer and a health care provider for an alternative rate of payment pursuant to Section 10133 shall specify that the …
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Cal. Ins. Code § 10603.04. Uniform benefits and coverage disclosure matrix required for policies covering dental services; effective date; requirements; availability to prospective insured; availability to group plan policyholders and group-eligible individuals; adoption of emergency regulations to implement section; application of section: Disability Insurance Disclosure – California
Introduced: Status: Enacted
A health insurer that issues, sells, renews, or offers a policy that covers dental services in this state, in addition to any other applicable disclosure requirements, shall use a uniform benefits and coverage disclosure matrix. …
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Cal. Ins. Code § 10954. Determining rate of health benefit plan for child; factors considered; limitations; notice relating to increased premiums; maintenance of coverage; rate identical to standard risk rate; documentation of coverage history; uniform model notice: Child Access to Health Insurance – California
Introduced: Status: Enacted
A carrier may use the following characteristics of an eligible child for purposes of establishing the rate of the health benefit plan for that child, where consistent with federal regulations under PPACA: age, geographic region, …
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Cal. Ins. Code § 10965.5. Prohibited activities relating to health status, claims experience, industry, occupation, or geographic location of individuals; discriminatory marketing practices: Individual Access to Health Insurance – California
Introduced: Status: Enacted
Commencing on October 1, 2013, a health insurer or agent or broker shall not, directly or indirectly, engage in the specified activities. Commencing on October 1, 2013, a health insurer shall not, directly or indirectly, …
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Cal. Ins. Code § 12693.26. Purchasing pool; contracts with entities that are not participating health, dental or vision plans; intra-agency agreements; exemption from competitive bidding: Healthy Families – California
Introduced: Status: Enacted
The board shall establish a purchasing pool for coverage of program subscribers to enable applicants without access to affordable and comprehensive employer-sponsored dependent coverage to provide their eligible children with health, dental, and vision benefits.
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Emanate Health et al v. Optum Health et al – California
District Court: California Central District Court Status: Pending
On November 20, 2023, Emanate Health filed an antitrust suit against Optum Health with the US District Court for the Central District of California. Specific …
FTC and California v. John Muir Health and Tenet Healthcare – California
District Court: Northern District of California Status: Decided
In November 2023, the FTC and the California AG challenged John Muir Health’s proposed acquisition of San Ramon Regional Medical Center from Tenet Healthcare. Both …
Pasadena Hospital d/b/a Huntington Hospital and Cedars-Sinai Health System v. California and Rob Bonta – California
District Court: Superior Court of California, County of Los Angeles Status: Decided
Pasadena Hospital d/b/a Cedars-Sinai Health System (Cedars-Sinai) and Huntington Memorial Hospital (Huntington) announced their intended affiliation in March 2020. The California AG’s office was concerned …
Texas et al. v. United States of America et al. – California, Federal, Texas
District Court: Northern District of Texas Status: Decided
[Consolidated with California et al. v. Texas et al. for Supreme Court review] This case arises out of the Supreme Court’s decision in NFIB v. …
People of the State of California ex rel. Xavier Becerra v. Sutter Health – California
District Court: Superior Court of California, County of San Francisco Status: Decided
On March 29, 2018, California’s attorney general filed an antitrust and unfair competition lawsuit against Sutter Health alleging that Sutter engaged in “all-or-nothing” contracts with …
Additional Resources
STATE BUDGET
California operates on an annual budget cycle. The fiscal year runs from July 1 through June 30. The Governor submits a proposed budget in January and the legislature adopts a budget in June.
REGULATION & ENFORCEMENT
- California was one of 16 states to file an amicus brief supporting the FTC’s winning position in the Ninth Circuit appeal of St. Luke’s Health Care Sys. v. FTC, No. 14-35173 (March 7, 2014), decided February 10, 2015. The States’ brief stated that the acceleration of health care costs due to the growth of large health care provider systems had become a matter of grave concern for the states.
KEY RESOURCES
- California State Legislature
- California Office of the Attorney General
- California Department of Health Care Services
- California Department of Insurance
- California Department of Finance