SB 523: Contraceptive Equity Act of 2022.
- Session Year: 2021-2022
- House: Senate
- Latest Version Date: 2022-09-27
(1)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 establishes health care coverage requirements for contraceptives, including, but not limited to, requiring a health care service plan, including a Medi-Cal managed care plan, or a health insurance policy issued, amended, renewed, or delivered on or after January 1, 2017, to cover up to a 12-month supply of federal Food and Drug Administration approved, self-administered hormonal contraceptives when dispensed at one time for an enrollee or insured by a provider or pharmacist, or at a location licensed or authorized to dispense drugs or supplies.
This bill, the Contraceptive Equity Act of 2022, would make various changes to expand coverage of contraceptives by a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on and after January 1, 2024, including requiring a health care service plan or health insurer to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost sharing or medical management restrictions. The bill would require health care service plans and insurance policies offered by public or private institutions of higher learning that directly provide health care services only to its students, faculty, staff, administration, and their respective dependents, issued, amended, renewed, or delivered, on or after January 1, 2024, to comply with these contraceptive coverage requirements. The bill would also require coverage for clinical services related to the provision or use of contraception, as specified. The bill would revise provisions applicable when a covered, therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by deferring to the provider, as specified.
This bill would also prohibit a health care service plan contract or disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, with certain exceptions, from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy services and procedures, as specified, under conditions similar to those applicable to other contraceptive coverage.
This bill would require a health benefit plan or contract with the Board of Public Relations of the Public Employees Retirement System to provide coverage for contraceptives and vasectomies consistent with the bills requirements, commencing January 1, 2024. The bill would prohibit the California State University and the University of California from approving a health benefit plan that does not comply with the contraceptive coverage requirements of the bill on and after January 1, 2024.
Because a willful violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.
(2)Existing law, the California Fair Employment and Housing Act (FEHA), establishes the Civil Rights Department within the Business, Consumer Services, and Housing Agency, under the direction of the Director of Civil Rights, to enforce civil rights laws with respect to housing and employment and to protect and safeguard the right of all persons to obtain and hold employment without discrimination based on specified characteristics or status, including, but not limited to, race, age, sex, or medical condition.
The FEHA makes certain discriminatory employment and housing practices unlawful, and authorizes a person claiming to be aggrieved by an alleged unlawful practice to file a verified complaint with the Civil Rights Department. The FEHA requires the department to make an investigation in connection with a filed complaint alleging facts sufficient to constitute a violation of the FEHA, and requires the department to endeavor to eliminate the unlawful practice by conference, conciliation, mediation, and persuasion. With regard to unlawful employment practices, if conference, conciliation, mediation, or persuasion fails and the department has required all parties to participate in a mandatory dispute resolution, as specified, the FEHA authorizes the director, in their discretion, to bring a civil action in the name of the department on behalf of the person claiming to be aggrieved.
This bill would revise the FEHA to include protection for reproductive health decisionmaking, as defined, with respect to the opportunity to seek, obtain, and hold employment without discrimination. Among other provisions, the bill would prohibit specified discriminatory practices, based on reproductive health decisionmaking, by employers, labor organizations, apprenticeships and training programs, and licensing boards. The bill also would make it unlawful for an employer to require, as a condition of employment, continued employment, or a benefit of employment, the disclosure of information relating to an applicants or employees reproductive health decisionmaking.
(3)This bill would incorporate additional changes to Section 12926 of the Government Code proposed by AB 1766 to be operative only if this bill and AB 1766 are enacted and this bill is enacted last.
(4)This bill would incorporate additional changes to Section 12931 of the Government Code proposed by AB 2960 to be operative only if this bill and AB 2960 are enacted and this bill is enacted last.
(5)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.
(1)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 establishes health care coverage requirements for contraceptives, including, but not limited to, requiring a health care service plan, including a Medi-Cal managed care plan, or a health insurance policy issued, amended, renewed, or delivered on or after January 1, 2017, to cover up to a 12-month supply of federal Food and Drug Administration approved, self-administered hormonal contraceptives when dispensed at one time for an enrollee or insured by a provider or pharmacist, or at a location licensed or authorized to dispense drugs or supplies.
This bill, the Contraceptive Equity Act of 2022, would make various changes to expand coverage of contraceptives by a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on and after January 1, 2024, including requiring a health care service plan or health insurer to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost sharing or medical management restrictions. The bill would require health care service plans and insurance policies offered by public or private institutions of higher learning that directly provide health care services only to its students, faculty, staff, administration, and their respective dependents, issued, amended, renewed, or delivered, on or after January 1, 2024, to comply with these contraceptive coverage requirements. The bill would also require coverage for clinical services related to the provision or use of contraception, as specified. The bill would revise provisions applicable when a covered, therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by deferring to the provider, as specified.
This bill would also prohibit a health care service plan contract or disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, with certain exceptions, from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy services and procedures, as specified, under conditions similar to those applicable to other contraceptive coverage.
This bill would require a health benefit plan or contract with the Board of Public Relations of the Public Employees Retirement System to provide coverage for contraceptives and vasectomies consistent with the bills requirements, commencing January 1, 2024. The bill would prohibit the California State University and the University of California from approving a health benefit plan that does not comply with the contraceptive coverage requirements of the bill on and after January 1, 2024.
Because a willful violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.
(2)Existing law, the California Fair Employment and Housing Act (FEHA), establishes the Civil Rights Department within the Business, Consumer Services, and Housing Agency, under the direction of the Director of Civil Rights, to enforce civil rights laws with respect to housing and employment and to protect and safeguard the right of all persons to obtain and hold employment without discrimination based on specified characteristics or status, including, but not limited to, race, age, sex, or medical condition.
The FEHA makes certain discriminatory employment and housing practices unlawful, and authorizes a person claiming to be aggrieved by an alleged unlawful practice to file a verified complaint with the Civil Rights Department. The FEHA requires the department to make an investigation in connection with a filed complaint alleging facts sufficient to constitute a violation of the FEHA, and requires the department to endeavor to eliminate the unlawful practice by conference, conciliation, mediation, and persuasion. With regard to unlawful employment practices, if conference, conciliation, mediation, or persuasion fails and the department has required all parties to participate in a mandatory dispute resolution, as specified, the FEHA authorizes the director, in their discretion, to bring a civil action in the name of the department on behalf of the person claiming to be aggrieved.
This bill would revise the FEHA to include protection for reproductive health decisionmaking, as defined, with respect to the opportunity to seek, obtain, and hold employment without discrimination. Among other provisions, the bill would prohibit specified discriminatory practices, based on reproductive health decisionmaking, by employers, labor organizations, apprenticeships and training programs, and licensing boards. The bill also would make it unlawful for an employer to require, as a condition of employment, continued employment, or a benefit of employment, the disclosure of information relating to an applicants or employees reproductive health decisionmaking.
(3)This bill would incorporate additional changes to Section 12926 of the Government Code proposed by AB 1766 to be operative only if this bill and AB 1766 are enacted and this bill is enacted last.
(4)This bill would incorporate additional changes to Section 12931 of the Government Code proposed by AB 2960 to be operative only if this bill and AB 2960 are enacted and this bill is enacted last.
(5)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.
(1)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 establishes health care coverage requirements for contraceptives, including, but not limited to, requiring a health care service plan, including a Medi-Cal managed care plan, or a health insurance policy issued, amended, renewed, or delivered on or after January 1, 2017, to cover up to a 12-month supply of federal Food and Drug Administration approved, self-administered hormonal contraceptives when dispensed at one time for an enrollee or insured by a provider or pharmacist, or at a location licensed or authorized to dispense drugs or supplies.
This bill, the Contraceptive Equity Act of 2022, would make various changes to expand coverage of contraceptives by a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on and after January 1, 2024, including requiring a health care service plan or health insurer to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost sharing or medical management restrictions. The bill would require health care service plans and insurance policies offered by public or private institutions of higher learning that directly provide health care services only to its students, faculty, staff, administration, and their respective dependents, issued, amended, renewed, or delivered, on or after January 1, 2024, to comply with these contraceptive coverage requirements. The bill would also require coverage for clinical services related to the provision or use of contraception, as specified. The bill would revise provisions applicable when a covered, therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by deferring to the provider, as specified.
This bill would also prohibit a health care service plan contract or disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, with certain exceptions, from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy services and procedures, as specified, under conditions similar to those applicable to other contraceptive coverage.
This bill would require a health benefit plan or contract with the Board of Public Relations of the Public Employees Retirement System to provide coverage for contraceptives and vasectomies consistent with the bills requirements, commencing January 1, 2024. The bill would prohibit the California State University and the University of California from approving a health benefit plan that does not comply with the contraceptive coverage requirements of the bill on and after January 1, 2024.
Because a willful violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.
(2)Existing law, the California Fair Employment and Housing Act (FEHA), establishes the Civil Rights Department within the Business, Consumer Services, and Housing Agency, under the direction of the Director of Civil Rights, to enforce civil rights laws with respect to housing and employment and to protect and safeguard the right of all persons to obtain and hold employment without discrimination based on specified characteristics or status, including, but not limited to, race, age, sex, or medical condition.
The FEHA makes certain discriminatory employment and housing practices unlawful, and authorizes a person claiming to be aggrieved by an alleged unlawful practice to file a verified complaint with the Civil Rights Department. The FEHA requires the department to make an investigation in connection with a filed complaint alleging facts sufficient to constitute a violation of the FEHA, and requires the department to endeavor to eliminate the unlawful practice by conference, conciliation, mediation, and persuasion. With regard to unlawful employment practices, if conference, conciliation, mediation, or persuasion fails and the department has required all parties to participate in a mandatory dispute resolution, as specified, the FEHA authorizes the director, in their discretion, to bring a civil action in the name of the department on behalf of the person claiming to be aggrieved.
This bill would revise the FEHA to include protection for reproductive health decisionmaking, as defined, with respect to the opportunity to seek, obtain, and hold employment without discrimination. Among other provisions, the bill would prohibit specified discriminatory practices, based on reproductive health decisionmaking, by employers, labor organizations, apprenticeships and training programs, and licensing boards. The bill also would make it unlawful for an employer to require, as a condition of employment, continued employment, or a benefit of employment, the disclosure of information relating to an applicants or employees reproductive health decisionmaking.
(3)This bill would incorporate additional changes to Section 12926 of the Government Code proposed by AB 1766 to be operative only if this bill and AB 1766 are enacted and this bill is enacted last.
(4)This bill would incorporate additional changes to Section 12931 of the Government Code proposed by AB 2960 to be operative only if this bill and AB 2960 are enacted and this bill is enacted last.
(3)(5)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.
(1)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 establishes health care coverage requirements for contraceptives, including, but not limited to, requiring a health care service plan, including a Medi-Cal managed care plan, or a health insurance policy issued, amended, renewed, or delivered on or after January 1, 2017, to cover up to a 12-month supply of federal Food and Drug Administration approved, self-administered hormonal contraceptives when dispensed at one time for an enrollee or insured by a provider or pharmacist, or at a location licensed or authorized to dispense drugs or supplies.
This bill, the Contraceptive Equity Act of 2021, 2022, would make various changes to expand coverage of contraceptives by a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on and after January 1, 2022, 2024, including requiring a health care service plan or health insurer to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost sharing or medical management restrictions. The bill would require health care service plans and insurance policies offered by public or private institutions of higher learning that directly provide health care services only to its students, faculty, staff, administration, and their respective dependents, approved issued, amended, renewed, or delivered, on or after January 1, 2023, 2024, to comply with these contraceptive coverage requirements. The bill would also require coverage for clinical services related to the provision or use of contraception, as specified. The bill would revise provisions applicable when a covered, therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by deferring to the attending provider, as specified.
This bill would also prohibit a health care service plan contract or disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2022, 2024, with certain exceptions, from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy services and procedures, as specified, under conditions similar to those applicable to other contraceptive coverage.
This bill would require a health benefit plan or contract with the Board of Public Relations of the Public Employees Retirement System to provide coverage for contraceptives and vasectomies consistent with the bills requirements, commencing January 1, 2022. 2024. The bill would prohibit the California State University and the University of California from approving a health benefit plan that does not comply with the contraceptive coverage requirements of the bill on and after January 1, 2022. 2024.
Because a willful violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.
(2)Existing law governs employment relations, defines the contract of employment, and establishes the obligations of employers to their employees. Existing law prohibits a person from discharging an employee or in any manner discriminating, retaliating, or taking any adverse action against an employee or applicant for employment because the employee or applicant has engaged in protected conduct. Existing law imposes civil penalties for a violation of these provisions and also imposes criminal penalties for certain violations. Existing law charges the Labor Commissioner with enforcement of these provisions.This bill would prohibit an employer from failing or refusing to hire, discharging, or otherwise discriminating or taking retaliatory personnel action against an individual with respect to compensation, terms, conditions, or privileges of employment because of the employees or their dependents reproductive health decisionmaking. The bill would make an employer, or any person acting on behalf of an employer, who takes an adverse employment action against an employee in violation of this provision liable to the aggrieved employee for a penalty and other appropriate relief to remedy the violation, pursuant to the above-described penalty provisions. The bill would require an employer, if that employer requires compliance with an employee handbook, to include in the handbook notice of the employee rights and remedies under this provision. By expanding the scope of a crime, the bill would impose a state-mandated local program.The(2)Existing law, the California Fair Employment and Housing Act (FEHA), establishes the Civil Rights Department within the Business, Consumer Services, and Housing Agency, under the direction of the Director of Civil Rights, to enforce civil rights laws with respect to housing and employment and to protect and safeguard the right of all persons to obtain and hold employment without discrimination based on specified characteristics or status, including, but not limited to, race, age, sex, or medical condition.
The FEHA makes certain discriminatory employment and housing practices unlawful, and authorizes a person claiming to be aggrieved by an alleged unlawful practice to file a verified complaint with the Civil Rights Department. The FEHA requires the department to make an investigation in connection with a filed complaint alleging facts sufficient to constitute a violation of the FEHA, and requires the department to endeavor to eliminate the unlawful practice by conference, conciliation, mediation, and persuasion. With regard to unlawful employment practices, if conference, conciliation, mediation, or persuasion fails and the department has required all parties to participate in a mandatory dispute resolution, as specified, the FEHA authorizes the director, in their discretion, to bring a civil action in the name of the department on behalf of the person claiming to be aggrieved.
This bill would revise the FEHA to include protection for reproductive health decisionmaking, as defined, with respect to the opportunity to seek, obtain, and hold employment without discrimination. Among other provisions, the bill would prohibit specified discriminatory practices, based on reproductive health decisionmaking, by employers, labor organizations, apprenticeships and training programs, and licensing boards. The bill also would make it unlawful for an employer to require, as a condition of employment, continued employment, or a benefit of employment, the disclosure of information relating to an applicants or employees reproductive health decisionmaking.
(3)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.
(1)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 establishes health care coverage requirements for contraceptives, including, but not limited to, requiring a health care service plan, including a Medi-Cal managed care plan, or a health insurance policy issued, amended, renewed, or delivered on or after January 1, 2017, to cover up to a 12-month supply of federal Food and Drug Administration approved, self-administered hormonal contraceptives when dispensed at one time for an enrollee or insured by a provider or pharmacist, or at a location licensed or authorized to dispense drugs or supplies.
This bill, the Contraceptive Equity Act of 2021, would make various changes to expand coverage of contraceptives by a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on and after January 1, 2022, including requiring a health care service plan or health insurer to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing cost sharing or medical management restrictions. The bill would require health care service plans and insurance policies offered by public or private institutions of higher learning that directly provide health care services only to its students, faculty, staff, administration, and their respective dependents, approved on or after January 1, 2023, to comply with these contraceptive coverage requirements. The bill would also require coverage for clinical services related to the provision or use of contraception, as specified. The bill would revise provisions applicable when a covered, therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by deferring to the attending provider, as specified.
This bill would also prohibit a health care service plan contract or disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2022, with certain exceptions, from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy coverage, services and procedures, as specified, under conditions similar to those applicable to other contraceptive coverage.
This bill would prohibit require a health benefit plan or contract with the Board of Public Relations of the Public Employees Retirement System, System to provide coverage for contraceptives and vasectomies consistent with the bills requirements, commencing January 1, 2022. The bill would prohibit the California State University, University and the University of California from approving or renewing a health benefit plan that does not comply with the contraceptive coverage requirements of the bill and existing law described above, on and after January 1, 2022.
Because a willful violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.
(2)Existing law governs employment relations, defines the contract of employment, and establishes the obligations of employers to their employees. Existing law prohibits a person from discharging an employee or in any manner discriminating, retaliating, or taking any adverse action against an employee or applicant for employment because the employee or applicant has engaged in protected conduct. Existing law imposes civil penalties for a violation of these provisions and also imposes criminal penalties for certain violations. Existing law charges the Labor Commissioner with enforcement of these provisions.
This bill would prohibit an employer from failing or refusing to hire, discharging, or otherwise discriminating or taking retaliatory personnel action against an individual with respect to compensation, terms, conditions, or privileges of employment because of the employees or their dependents reproductive health decisionmaking. The bill would make an employer, or any person acting on behalf of an employer, who takes an adverse employment action against an employee in violation of this provision liable to the aggrieved employee for a penalty and other appropriate relief to remedy the violation, pursuant to the above-described penalty provisions. The bill would require an employer, if that employer requires compliance with an employee handbook, to include in the handbook notice of the employee rights and remedies under this provision. By expanding the scope of 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.
(1)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 establishes health care coverage requirements for contraceptives, including, but not limited to, requiring a health care service plan, including a Medi-Cal managed care plan, or a health insurance policy issued, amended, renewed, or delivered on or after January 1, 2017, to cover up to a 12-month supply of federal Food and Drug Administration approved, self-administered hormonal contraceptives when dispensed at one time for an enrollee or insured by a provider or pharmacist, or at a location licensed or authorized to dispense drugs or supplies.
This bill, the Contraceptive Equity Act of 2021, would make various changes to expand coverage of contraceptives by a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on and after January 1, 2022, including requiring a health care service plan or health insurer to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing or medical management restrictions and to reimburse enrollees and insureds for out-of-pocket costs for over-the-counter birth control methods purchased at any out-of-network pharmacy or retailer in California, without medical management restrictions. The bill would require health care service plans and insurance policies offered by public or private institutions of higher learning that directly provide health care services only to its students, faculty, staff, administration, and their respective dependents, approved on or after January 1, 2023, to comply with these contraceptive coverage requirements. The bill would also require coverage for clinical services related to the provision or use of contraception, as specified. The bill would revise provisions applicable when a covered, therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by deferring to the attending provider, as specified.
This bill would also prohibit a health care service plan contract or disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2022, with certain exceptions, from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy coverage, as specified, under conditions similar to those applicable to other contraceptive coverage.
This bill would prohibit the Board of Public Relations of the Public Employees Retirement System, the California State University, and the University of California from approving or renewing a health benefit plan that does not comply with the contraceptive coverage requirements of the bill and existing law described above, on and after January 1, 2022.
Because a willful violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.
(2)Existing law governs employment relations, defines the contract of employment, and establishes the obligations of employers to their employees. Existing law prohibits a person from discharging an employee or in any manner discriminating, retaliating, or taking any adverse action against an employee or applicant for employment because the employee or applicant has engaged in protected conduct. Existing law imposes civil penalties for a violation of these provisions and also imposes criminal penalties for certain violations. Existing law charges the Labor Commissioner with enforcement of these provisions.
This bill would prohibit an employer from failing or refusing to hire, discharging, or otherwise discriminating or taking retaliatory personnel action against an individual with respect to compensation, terms, conditions, or privileges of employment because of the employees or their dependents reproductive health decisionmaking. The bill would make an employer, or any person acting on behalf of an employer, who takes an adverse employment action against an employee in violation of this provision liable to the aggrieved employee for a penalty and other appropriate relief to remedy the violation, pursuant to the above-described penalty provisions. The bill would require an employer, if that employer requires compliance with an employee handbook, to include in the handbook notice of the employee rights and remedies under this provision. By expanding the scope of 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.
(1)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 establishes health care coverage requirements for contraceptives, including, but not limited to, requiring a health care service plan, including a Medi-Cal managed care plan, or a health insurance policy issued, amended, renewed, or delivered on or after January 1, 2017, to cover up to a 12-month supply of federal Food and Drug Administration approved, self-administered hormonal contraceptives when dispensed at one time for an enrollee or insured by a provider or pharmacist, or at a location licensed or authorized to dispense drugs or supplies.
This bill, the Contraceptive Equity Act of 2021, would make various changes to expand coverage of contraceptives by a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on and after January 1, 2022, including requiring a health care service plan or health insurer to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing or medical management restrictions and to reimburse enrollees and insureds for out-of-pocket costs for over-the-counter birth control methods purchased at any out-of-network pharmacy or retailer in California, without medical management restrictions. The bill would require health care service plans and insurance policies offered by public or private institutions of higher learning that directly provide health care services only to its students, faculty, staff, administration, and their respective dependents, approved on or after January 1, 2023, to comply with these contraceptive coverage requirements. The bill would also require coverage for clinical services related to the provision or use of contraception, as specified. The bill would revise provisions applicable when a covered, therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by deferring to the attending provider, as specified. The bill would prohibit a religious employer, as defined, that requests and is provided a health care service plan contract or health insurance policy without coverage for FDA-approved contraceptive methods that are contrary to the religious employers religious tenets, from discriminating or retaliating against the employee for independently obtaining contraceptives outside of the employers plan or policy under this authorization.
This bill would prohibit the Board of Public Relations of the Public Employees Retirement System and System, the California State University, and the University of California from approving or renewing a health benefit plan that does not comply with the contraceptive coverage requirements of the bill and existing law described above, on and after January 1, 2022.
Because a willful violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.
(2)Existing law governs employment relations, defines the contract of employment, and establishes the obligations of employers to their employees. Existing law prohibits a person from discharging an employee or in any manner discriminating, retaliating, or taking any adverse action against an employee or applicant for employment because the employee or applicant has engaged in protected conduct. Existing law imposes civil penalties for a violation of these provisions and also imposes criminal penalties for certain violations. Existing law charges the Labor Commissioner with enforcement of these provisions.
This bill would prohibit an employer from failing or refusing to hire, discharging, or otherwise discriminating or taking retaliatory personnel action against an individual with respect to compensation, terms, conditions, or privileges of employment because of the employees or their dependents reproductive health decisionmaking. The bill would make an employer, or any person acting on behalf of an employer, who takes an adverse employment action against an employee in violation of this provision liable to the aggrieved employee for a penalty and other appropriate relief to remedy the violation, pursuant to the above-described penalty provisions. The bill would require an employer, if that employer requires compliance with an employee handbook, to include in the handbook notice of the employee rights and remedies under this provision. By expanding the scope of 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.
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 establishes health care coverage requirements for contraceptives, including, but not limited to, requiring a health care service plan, including a Medi-Cal managed care plan, or a health insurance policy issued, amended, renewed, or delivered on or after January 1, 2017, to cover up to a 12-month supply of federal Food and Drug Administration approved, self-administered hormonal contraceptives when dispensed at one time for an enrollee or insured by a provider or pharmacist, or at a location licensed or authorized to dispense drugs or supplies.
This bill, the Contraceptive Equity Act of 2021, would make various changes to expand coverage of contraceptives by a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on and after January 1, 2022, including requiring a health care service plan or health insurer to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing or medical management restrictions and to reimburse enrollees and insureds for out-of-pocket costs for over-the-counter birth control methods purchased at any out-of-network pharmacy in California, without medical management restrictions. The bill would also require coverage for clinical services related to the provision or use of contraception, as specified. The bill would revise provisions applicable when a covered, therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by deferring to the attending provider, as specified.
With respect to religious employers, this bill would authorize an enrollee or insured to submit a request to the health care service plan or health insurer if the employer elects not to purchase coverage for contraceptive methods, as required by existing law. The bill would require the applicable department to reimburse a religious employer for the contraceptive care and related products provided to the employee, as specified. The bill would prohibit the employer The bill would prohibit a religious employer, as defined, that requests and is provided a health care service plan contract or health insurance policy without coverage for FDA-approved contraceptive methods that are contrary to the religious employers religious tenets, from discriminating or retaliating against the employee for independently obtaining contraceptives outside of the employers plan or policy under this authorization.
This bill would prohibit the Board of Public Relations of the Public Employees Retirement System and the University of California from approving or renewing a health benefit plan that does not comply with the contraceptive coverage requirements of the bill and existing law described above, on and after January 1, 2022.
Because a willful violation of the bills requirements by a health care service plan 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.
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 establishes health care coverage requirements for contraceptives, including, but not limited to, requiring a health care service plan, including a Medi-Cal managed care plan, or a health insurance policy issued, amended, renewed, or delivered on or after January 1, 2017, to cover up to a 12-month supply of federal Food and Drug Administration approved, self-administered hormonal contraceptives when dispensed at one time for an enrollee or insured by a provider or pharmacist, or at a location licensed or authorized to dispense drugs or supplies.
This bill, the Contraceptive Equity Act of 2021, would make various changes to expand coverage of contraceptives by a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on and after January 1, 2022, including requiring a health care service plan or health insurer to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing or medical management restrictions and to reimburse enrollees and insureds for out-of-pocket costs for over-the-counter birth control methods purchased at any out-of-network pharmacy in California, without medical management restrictions. The bill would also require coverage for clinical services related to the provision or use of contraception, as specified. The bill would revise provisions applicable when a covered, therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by deferring to the attending provider, as specified.
With respect to religious employers, this bill would authorize an enrollee or insured to submit a request to the health care service plan or health insurer if the employer elects not to purchase coverage for contraceptive methods, as required by existing law. The bill would require the applicable department to reimburse a religious employer for the contraceptive care and related products provided to the employee, as specified. The bill would prohibit the employer from discriminating or retaliating against the employee for independently obtaining contraceptives outside of the employers plan under this authorization.
This bill would prohibit the Board of Public Relations of the Public Employees Retirement System and the University of California from approving or renewing a health benefit plan that does not comply with the contraceptive coverage requirements of the bill and existing law described above, on and after January 1, 2022.
Because a willful violation of the bills requirements by a health care service plan 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.
This act shall be known, and may be cited, as the Contraceptive Equity Act of 2022.
SEC. 2.The Legislature finds and declares all of the following:
(a)California has a long history of expanding timely access to birth control to prevent unintended pregnancy. Thanks to a combination of innovative policies and programs enacted statewide, unintended pregnancy rates are at a 30-year low.
(b)Despite the progress made, health disparities in reproductive health outcomes persist among Black, Indigenous and People of Color, including disproportionate unintended pregnancy, infant and maternal mortality, and sexually transmitted infection rates. The Legislature must take action to ensure that all Californians have equitable access to preventive contraceptive care.
(c)The federal Patient Protection and Affordable Care Act (Public Law 111-148) included a mandate that most health insurance plans cover contraception without out-of-pocket costs for patients.
(d)Californias Contraceptive Coverage Equity Act of 2014 and the Annual Supply of Contraceptives Act of 2016, built on this federal policy and existing state law to be the first state in the country to require coverage of birth control methods approved by the federal Food and Drug Administration for women without cost sharing or restrictions and a 12-month supply of self-administered birth control dispensed at one time for individuals enrolled in health insurance plans and policies regulated by the Knox-Keene Health Care Service Plan Act of 1975.
(e)Since 2014, several other states have expanded on Californias model legislation to create more equitable contraceptive coverage and access by requiring most health insurance plans and policies to cover voluntary sterilization services and all birth control methods available over-the-counter without a prescription for all beneficiaries, regardless of gender.
(f)A report by the Guttmacher Institute shows that vasectomy is among the most effective and cost-effective contraceptive methods available.
(g)Trump-era attacks on birth control access have underscored the need to codify the expansion of contraceptive coverage for as many Californians as possible under state law.
(h)The COVID-19 public health emergency has also further illuminated the structural inequities that disproportionately affect youth, low-income people and communities of color in accessing birth control services. A report by the Guttmacher Institute revealed that 29 percent of White women, 38 percent of Black women and 45 percent of Latinas now face difficulties accessing birth control as a result of the pandemic.
(i)The Legislature intends to reduce sexual and reproductive health disparities and ensure greater health equity by providing a pathway for more Californians to get the contraceptive care they want, when they need it without inequitable delays or cost barriers.
(j)The Legislature intends for the relevant California departments and agencies to work in concert to ensure compliance with these provisions.
SEC. 3.Section 12920 of the Government Code is amended to read:12920.It is hereby declared as the public policy of this state that it is necessary to protect and safeguard the right and opportunity of all persons to seek, obtain, and hold employment without discrimination or abridgment on account of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or military and veteran status.
It is recognized that the practice of denying employment opportunity and discriminating in the terms of employment for these reasons foments domestic strife and unrest, deprives the state of the fullest utilization of its capacities for development and advancement, and substantially and adversely affects the interests of employees, employers, and the public in general.
Further, the practice of discrimination because of race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, familial status, source of income, disability, veteran or military status, or genetic information in housing accommodations is declared to be against public policy.
It is the purpose of this part to provide effective remedies that will eliminate these discriminatory practices.
This part shall be deemed an exercise of the police power of the state for the protection of the welfare, health, and peace of the people of this state.
SEC. 4.Section 12921 of the Government Code is amended to read:12921.(a)The opportunity to seek, obtain, and hold employment without discrimination because of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status is hereby recognized as and declared to be a civil right.
(b)The opportunity to seek, obtain, and hold housing without discrimination because of race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, familial status, source of income, disability, veteran or military status, genetic information, or any other basis prohibited by Section 51 of the Civil Code is hereby recognized as and declared to be a civil right.
SEC. 5.Section 12926 of the Government Code is amended to read:12926.As used in this part in connection with unlawful practices, unless a different meaning clearly appears from the context:
(a)Affirmative relief or prospective relief includes the authority to order reinstatement of an employee, awards of backpay, reimbursement of out-of-pocket expenses, hiring, transfers, reassignments, grants of tenure, promotions, cease and desist orders, posting of notices, training of personnel, testing, expunging of records, reporting of records, and any other similar relief that is intended to correct unlawful practices under this part.
(b)Age refers to the chronological age of any individual who has reached a 40th birthday.
(c)Except as provided by Section 12926.05, employee does not include any individual employed by that persons parent, spouse, or child or any individual employed under a special license in a nonprofit sheltered workshop or rehabilitation facility.
(d)Employer includes any person regularly employing five or more persons, or any person acting as an agent of an employer, directly or indirectly, the state or any political or civil subdivision of the state, and cities, except as follows:
Employer does not include a religious association or corporation not organized for private profit.
(e)Employment agency includes any person undertaking for compensation to procure employees or opportunities to work.
(f)Essential functions means the fundamental job duties of the employment position the individual with a disability holds or desires. Essential functions does not include the marginal functions of the position.
(1)A job function may be considered essential for any of several reasons, including, but not limited to, any one or more of the following:
(A)The function may be essential because the reason the position exists is to perform that function.
(B)The function may be essential because of the limited number of employees available among whom the performance of that job function can be distributed.
(C)The function may be highly specialized, so that the incumbent in the position is hired based on expertise or the ability to perform a particular function.
(2)Evidence of whether a particular function is essential includes, but is not limited to, the following:
(A)The employers judgment as to which functions are essential.
(B)Written job descriptions prepared before advertising or interviewing applicants for the job.
(C)The amount of time spent on the job performing the function.
(D)The consequences of not requiring the incumbent to perform the function.
(E)The terms of a collective bargaining agreement.
(F)The work experiences of past incumbents in the job.
(G)The current work experience of incumbents in similar jobs.
(g)(1)Genetic information means, with respect to any individual, information about any of the following:
(A)The individuals genetic tests.
(B)The genetic tests of family members of the individual.
(C)The manifestation of a disease or disorder in family members of the individual.
(2)Genetic information includes any request for, or receipt of, genetic services, or participation in clinical research that includes genetic services, by an individual or any family member of the individual.
(3)Genetic information does not include information about the sex or age of any individual.
(h)Labor organization includes any organization that exists and is constituted for the purpose, in whole or in part, of collective bargaining or of dealing with employers concerning grievances, terms or conditions of employment, or of other mutual aid or protection.
(i)Medical condition means either of the following:
(1)Any health impairment related to or associated with a diagnosis of cancer or a record or history of cancer.
(2)Genetic characteristics. For purposes of this section, genetic characteristics means either of the following:
(A)Any scientifically or medically identifiable gene or chromosome, or combination or alteration thereof, that is known to be a cause of a disease or disorder in a person or that persons offspring, or that is determined to be associated with a statistically increased risk of development of a disease or disorder, and that is presently not associated with any symptoms of any disease or disorder.
(B)Inherited characteristics that may derive from the individual or family member, that are known to be a cause of a disease or disorder in a person or that persons offspring, or that are determined to be associated with a statistically increased risk of development of a disease or disorder, and that are presently not associated with any symptoms of any disease or disorder.
(j)Mental disability includes, but is not limited to, all of the following:
(1)Having any mental or psychological disorder or condition, such as intellectual disability, organic brain syndrome, emotional or mental illness, or specific learning disabilities, that limits a major life activity. For purposes of this section:
(A)Limits shall be determined without regard to mitigating measures, such as medications, assistive devices, or reasonable accommodations, unless the mitigating measure itself limits a major life activity.
(B)A mental or psychological disorder or condition limits a major life activity if it makes the achievement of the major life activity difficult.
(C)Major life activities shall be broadly construed and shall include physical, mental, and social activities and working.
(2)Any other mental or psychological disorder or condition not described in paragraph (1) that requires special education or related services.
(3)Having a record or history of a mental or psychological disorder or condition described in paragraph (1) or (2), which is known to the employer or other entity covered by this part.
(4)Being regarded or treated by the employer or other entity covered by this part as having, or having had, any mental condition that makes achievement of a major life activity difficult.
(5)Being regarded or treated by the employer or other entity covered by this part as having, or having had, a mental or psychological disorder or condition that has no present disabling effect, but that may become a mental disability as described in paragraph (1) or (2).
Mental disability does not include sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from the current unlawful use of controlled substances or other drugs.
(k)Veteran or military status means a member or veteran of the United States Armed Forces, United States Armed Forces Reserve, the United States National Guard, and the California National Guard.
(l)On the bases enumerated in this part means or refers to discrimination on the basis of one or more of the following: race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, sexual orientation, reproductive health decisionmaking, or veteran or military status.
(m)Physical disability includes, but is not limited to, all of the following:
(1)Having any physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss that does both of the following:
(A)Affects one or more of the following body systems: neurological, immunological, musculoskeletal, special sense organs, respiratory, including speech organs, cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine.
(B)Limits a major life activity. For purposes of this section:
(i)Limits shall be determined without regard to mitigating measures such as medications, assistive devices, prosthetics, or reasonable accommodations, unless the mitigating measure itself limits a major life activity.
(ii)A physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss limits a major life activity if it makes the achievement of the major life activity difficult.
(iii)Major life activities shall be broadly construed and includes physical, mental, and social activities and working.
(2)Any other health impairment not described in paragraph (1) that requires special education or related services.
(3)Having a record or history of a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment described in paragraph (1) or (2), which is known to the employer or other entity covered by this part.
(4)Being regarded or treated by the employer or other entity covered by this part as having, or having had, any physical condition that makes achievement of a major life activity difficult.
(5)Being regarded or treated by the employer or other entity covered by this part as having, or having had, a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment that has no present disabling effect but may become a physical disability as described in paragraph (1) or (2).
(6)Physical disability does not include sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from the current unlawful use of controlled substances or other drugs.
(n)Notwithstanding subdivisions (j) and (m), if the definition of disability used in the federal Americans with Disabilities Act of 1990 (Public Law 101-336) would result in broader protection of the civil rights of individuals with a mental disability or physical disability, as defined in subdivision (j) or (m), or would include any medical condition not included within those definitions, then that broader protection or coverage shall be deemed incorporated by reference into, and shall prevail over conflicting provisions of, the definitions in subdivisions (j) and (m).
(o)Race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, sexual orientation, reproductive health decisionmaking, or veteran or military status includes a perception that the person has any of those characteristics or that the person is associated with a person who has, or is perceived to have, any of those characteristics.
(p)Reasonable accommodation may include either of the following:
(1)Making existing facilities used by employees readily accessible to, and usable by, individuals with disabilities.
(2)Job restructuring, part-time or modified work schedules, reassignment to a vacant position, acquisition or modification of equipment or devices, adjustment or modifications of examinations, training materials or policies, the provision of qualified readers or interpreters, and other similar accommodations for individuals with disabilities.
(q)Religious creed, religion, religious observance, religious belief, and creed include all aspects of religious belief, observance, and practice, including religious dress and grooming practices. Religious dress practice shall be construed broadly to include the wearing or carrying of religious clothing, head or face coverings, jewelry, artifacts, and any other item that is part of an individual observing a religious creed. Religious grooming practice shall be construed broadly to include all forms of head, facial, and body hair that are part of an individual observing a religious creed.
(r)(1)Sex includes, but is not limited to, the following:
(A)Pregnancy or medical conditions related to pregnancy.
(B)Childbirth or medical conditions related to childbirth.
(C)Breastfeeding or medical conditions related to breastfeeding.
(2)Sex also includes, but is not limited to, a persons gender. Gender means sex, and includes a persons gender identity and gender expression. Gender expression means a persons gender-related appearance and behavior whether or not stereotypically associated with the persons assigned sex at birth.
(s)Sexual orientation means heterosexuality, homosexuality, and bisexuality.
(t)Supervisor means any individual having the authority, in the interest of the employer, to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline other employees, or the responsibility to direct them, or to adjust their grievances, or effectively to recommend that action, if, in connection with the foregoing, the exercise of that authority is not of a merely routine or clerical nature, but requires the use of independent judgment.
(u)Undue hardship means an action requiring significant difficulty or expense, when considered in light of the following factors:
(1)The nature and cost of the accommodation needed.
(2)The overall financial resources of the facilities involved in the provision of the reasonable accommodations, the number of persons employed at the facility, and the effect on expenses and resources or the impact otherwise of these accommodations upon the operation of the facility.
(3)The overall financial resources of the covered entity, the overall size of the business of a covered entity with respect to the number of employees, and the number, type, and location of its facilities.
(4)The type of operations, including the composition, structure, and functions of the workforce of the entity.
(5)The geographic separateness or administrative or fiscal relationship of the facility or facilities.
(v)National origin discrimination includes, but is not limited to, discrimination on the basis of possessing a drivers license granted under Section 12801.9 of the Vehicle Code.
(w)Race is inclusive of traits historically associated with race, including, but not limited to, hair texture and protective hairstyles.
(x)Protective hairstyles includes, but is not limited to, such hairstyles as braids, locks, and twists.
(y)Reproductive health decisionmaking includes, but is not limited to, a decision to use or access a particular drug, device, product, or medical service for reproductive health. This subdivision and other provisions in this part relating to reproductive health decisionmaking shall not be construed to mean that subdivision (r) of this section and other provisions in this part related to sex do not include reproductive health decisionmaking.
SEC. 5.5.Section 12926 of the Government Code is amended to read:12926.As used in this part in connection with unlawful practices, unless a different meaning clearly appears from the context:
(a)Affirmative relief or prospective relief includes the authority to order reinstatement of an employee, awards of backpay, reimbursement of out-of-pocket expenses, hiring, transfers, reassignments, grants of tenure, promotions, cease and desist orders, posting of notices, training of personnel, testing, expunging of records, reporting of records, and any other similar relief that is intended to correct unlawful practices under this part.
(b)Age refers to the chronological age of any individual who has reached a 40th birthday.
(c)Except as provided by Section 12926.05, employee does not include any individual employed by that persons parent, spouse, or child or any individual employed under a special license in a nonprofit sheltered workshop or rehabilitation facility.
(d)Employer includes any person regularly employing five or more persons, or any person acting as an agent of an employer, directly or indirectly, the state or any political or civil subdivision of the state, and cities, except as follows:
Employer does not include a religious association or corporation not organized for private profit.
(e)Employment agency includes any person undertaking for compensation to procure employees or opportunities to work.
(f)Essential functions means the fundamental job duties of the employment position the individual with a disability holds or desires. Essential functions does not include the marginal functions of the position.
(1)A job function may be considered essential for any of several reasons, including, but not limited to, any one or more of the following:
(A)The function may be essential because the reason the position exists is to perform that function.
(B)The function may be essential because of the limited number of employees available among whom the performance of that job function can be distributed.
(C)The function may be highly specialized, so that the incumbent in the position is hired based on expertise or the ability to perform a particular function.
(2)Evidence of whether a particular function is essential includes, but is not limited to, the following:
(A)The employers judgment as to which functions are essential.
(B)Written job descriptions prepared before advertising or interviewing applicants for the job.
(C)The amount of time spent on the job performing the function.
(D)The consequences of not requiring the incumbent to perform the function.
(E)The terms of a collective bargaining agreement.
(F)The work experiences of past incumbents in the job.
(G)The current work experience of incumbents in similar jobs.
(g)(1)Genetic information means, with respect to any individual, information about any of the following:
(A)The individuals genetic tests.
(B)The genetic tests of family members of the individual.
(C)The manifestation of a disease or disorder in family members of the individual.
(2)Genetic information includes any request for, or receipt of, genetic services, or participation in clinical research that includes genetic services, by an individual or any family member of the individual.
(3)Genetic information does not include information about the sex or age of any individual.
(h)Labor organization includes any organization that exists and is constituted for the purpose, in whole or in part, of collective bargaining or of dealing with employers concerning grievances, terms or conditions of employment, or of other mutual aid or protection.
(i)Medical condition means either of the following:
(1)Any health impairment related to or associated with a diagnosis of cancer or a record or history of cancer.
(2)Genetic characteristics. For purposes of this section, genetic characteristics means either of the following:
(A)Any scientifically or medically identifiable gene or chromosome, or combination or alteration thereof, that is known to be a cause of a disease or disorder in a person or that persons offspring, or that is determined to be associated with a statistically increased risk of development of a disease or disorder, and that is presently not associated with any symptoms of any disease or disorder.
(B)Inherited characteristics that may derive from the individual or family member, that are known to be a cause of a disease or disorder in a person or that persons offspring, or that are determined to be associated with a statistically increased risk of development of a disease or disorder, and that are presently not associated with any symptoms of any disease or disorder.
(j)Mental disability includes, but is not limited to, all of the following:
(1)Having any mental or psychological disorder or condition, such as intellectual disability, organic brain syndrome, emotional or mental illness, or specific learning disabilities, that limits a major life activity. For purposes of this section:
(A)Limits shall be determined without regard to mitigating measures, such as medications, assistive devices, or reasonable accommodations, unless the mitigating measure itself limits a major life activity.
(B)A mental or psychological disorder or condition limits a major life activity if it makes the achievement of the major life activity difficult.
(C)Major life activities shall be broadly construed and shall include physical, mental, and social activities and working.
(2)Any other mental or psychological disorder or condition not described in paragraph (1) that requires special education or related services.
(3)Having a record or history of a mental or psychological disorder or condition described in paragraph (1) or (2), which is known to the employer or other entity covered by this part.
(4)Being regarded or treated by the employer or other entity covered by this part as having, or having had, any mental condition that makes achievement of a major life activity difficult.
(5)Being regarded or treated by the employer or other entity covered by this part as having, or having had, a mental or psychological disorder or condition that has no present disabling effect, but that may become a mental disability as described in paragraph (1) or (2).
Mental disability does not include sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from the current unlawful use of controlled substances or other drugs.
(k)Veteran or military status means a member or veteran of the United States Armed Forces, United States Armed Forces Reserve, the United States National Guard, and the California National Guard.
(l)On the bases enumerated in this part means or refers to discrimination on the basis of one or more of the following: race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, sexual orientation, reproductive health decisionmaking, or veteran or military status.
(m)Physical disability includes, but is not limited to, all of the following:
(1)Having any physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss that does both of the following:
(A)Affects one or more of the following body systems: neurological, immunological, musculoskeletal, special sense organs, respiratory, including speech organs, cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine.
(B)Limits a major life activity. For purposes of this section:
(i)Limits shall be determined without regard to mitigating measures such as medications, assistive devices, prosthetics, or reasonable accommodations, unless the mitigating measure itself limits a major life activity.
(ii)A physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss limits a major life activity if it makes the achievement of the major life activity difficult.
(iii)Major life activities shall be broadly construed and includes physical, mental, and social activities and working.
(2)Any other health impairment not described in paragraph (1) that requires special education or related services.
(3)Having a record or history of a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment described in paragraph (1) or (2), which is known to the employer or other entity covered by this part.
(4)Being regarded or treated by the employer or other entity covered by this part as having, or having had, any physical condition that makes achievement of a major life activity difficult.
(5)Being regarded or treated by the employer or other entity covered by this part as having, or having had, a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment that has no present disabling effect but may become a physical disability as described in paragraph (1) or (2).
(6)Physical disability does not include sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from the current unlawful use of controlled substances or other drugs.
(n)Notwithstanding subdivisions (j) and (m), if the definition of disability used in the federal Americans with Disabilities Act of 1990 (Public Law 101-336) would result in broader protection of the civil rights of individuals with a mental disability or physical disability, as defined in subdivision (j) or (m), or would include any medical condition not included within those definitions, then that broader protection or coverage shall be deemed incorporated by reference into, and shall prevail over conflicting provisions of, the definitions in subdivisions (j) and (m).
(o)Race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, sexual orientation, reproductive health decisionmaking, or veteran or military status includes a perception that the person has any of those characteristics or that the person is associated with a person who has, or is perceived to have, any of those characteristics.
(p)Reasonable accommodation may include either of the following:
(1)Making existing facilities used by employees readily accessible to, and usable by, individuals with disabilities.
(2)Job restructuring, part-time or modified work schedules, reassignment to a vacant position, acquisition or modification of equipment or devices, adjustment or modifications of examinations, training materials or policies, the provision of qualified readers or interpreters, and other similar accommodations for individuals with disabilities.
(q)Religious creed, religion, religious observance, religious belief, and creed include all aspects of religious belief, observance, and practice, including religious dress and grooming practices. Religious dress practice shall be construed broadly to include the wearing or carrying of religious clothing, head or face coverings, jewelry, artifacts, and any other item that is part of an individual observing a religious creed. Religious grooming practice shall be construed broadly to include all forms of head, facial, and body hair that are part of an individual observing a religious creed.
(r)(1)Sex includes, but is not limited to, the following:
(A)Pregnancy or medical conditions related to pregnancy.
(B)Childbirth or medical conditions related to childbirth.
(C)Breastfeeding or medical conditions related to breastfeeding.
(2)Sex also includes, but is not limited to, a persons gender. Gender means sex, and includes a persons gender identity and gender expression. Gender expression means a persons gender-related appearance and behavior whether or not stereotypically associated with the persons assigned sex at birth.
(s)Sexual orientation means heterosexuality, homosexuality, and bisexuality.
(t)Supervisor means any individual having the authority, in the interest of the employer, to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline other employees, or the responsibility to direct them, or to adjust their grievances, or effectively to recommend that action, if, in connection with the foregoing, the exercise of that authority is not of a merely routine or clerical nature, but requires the use of independent judgment.
(u)Undue hardship means an action requiring significant difficulty or expense, when considered in light of the following factors:
(1)The nature and cost of the accommodation needed.
(2)The overall financial resources of the facilities involved in the provision of the reasonable accommodations, the number of persons employed at the facility, and the effect on expenses and resources or the impact otherwise of these accommodations upon the operation of the facility.
(3)The overall financial resources of the covered entity, the overall size of the business of a covered entity with respect to the number of employees, and the number, type, and location of its facilities.
(4)The type of operations, including the composition, structure, and functions of the workforce of the entity.
(5)The geographic separateness or administrative or fiscal relationship of the facility or facilities.
(v)National origin discrimination includes, but is not limited to, discrimination on the basis of possessing a drivers license or identification card granted under Section 12801.9 of the Vehicle Code.
(w)Race is inclusive of traits historically associated with race, including, but not limited to, hair texture and protective hairstyles.
(x)Protective hairstyles includes, but is not limited to, such hairstyles as braids, locks, and twists.
(y)Reproductive health decisionmaking includes, but is not limited to, a decision to use or access a particular drug, device, product, or medical service for reproductive health. This subdivision and other provisions in this part relating to reproductive health decisionmaking shall not be construed to mean that subdivision (r) of this section and other provisions in this part related to sex do not include reproductive health decisionmaking.
SEC. 6.Section 12931 of the Government Code is amended to read:12931.The department may also provide assistance to communities and persons therein in resolving disputes, disagreements, or difficulties relating to discriminatory practices based on race, religious creed, color, national origin, ancestry, physical disability, mental disability, veteran or military status, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, familial status, age, reproductive health decisionmaking, or sexual orientation that impair the rights of persons in those communities under the Constitution or laws of the United States or of this state. The services of the department may be made available in cases of these disputes, disagreements, or difficulties only when, in its judgment, peaceful relations among the citizens of the community involved are threatened thereby. The departments services are to be made available only upon the request of an appropriate state or local public body, or upon the request of any person directly affected by any such dispute, disagreement, or difficulty.
The assistance of the department pursuant to this section shall be limited to endeavors at investigation, conference, conciliation, and persuasion.
SEC. 6.5.Section 12931 of the Government Code is amended to read:12931.The department may also provide assistance to communities and persons therein in resolving disputes, disagreements, or difficulties relating to discriminatory practices based on race, religious creed, color, national origin, ancestry, physical disability, mental disability, veteran or military status, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, familial status, age, reproductive health decisionmaking, or sexual orientation that impair the rights of persons in those communities under the Constitution or laws of the United States or of this state. The services of the department may be made available in cases of these disputes, disagreements, or difficulties only when, in its judgment, peaceful relations among the persons of the community involved are threatened thereby. The departments services are to be made available only upon the request of an appropriate state or local public body, or upon the request of any person directly affected by the dispute, disagreement, or difficulty.
The assistance of the department pursuant to this section shall be limited to endeavors at investigation, conference, conciliation, and persuasion.
SEC. 7.Section 12940 of the Government Code, as amended by Section 36 of Chapter 48 of the Statutes of 2022, is amended to read:12940.It is an unlawful employment practice, unless based upon a bona fide occupational qualification, or, except where based upon applicable security regulations established by the United States or the State of California:
(a)For an employer, because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decisionmaking, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, or veteran or military status of any person, to refuse to hire or employ the person or to refuse to select the person for a training program leading to employment, or to bar or to discharge the person from employment or from a training program leading to employment, or to discriminate against the person in compensation or in terms, conditions, or privileges of employment.
(1)This part does not prohibit an employer from refusing to hire or discharging an employee with a physical or mental disability, or subject an employer to any legal liability resulting from the refusal to employ or the discharge of an employee with a physical or mental disability, if the employee, because of a physical or mental disability, is unable to perform the employees essential duties even with reasonable accommodations, or cannot perform those duties in a manner that would not endanger the employees health or safety or the health or safety of others even with reasonable accommodations.
(2)This part does not prohibit an employer from refusing to hire or discharging an employee who, because of the employees medical condition, is unable to perform the employees essential duties even with reasonable accommodations, or cannot perform those duties in a manner that would not endanger the employees health or safety or the health or safety of others even with reasonable accommodations. Nothing in this part shall subject an employer to any legal liability resulting from the refusal to employ or the discharge of an employee who, because of the employees medical condition, is unable to perform the employees essential duties, or cannot perform those duties in a manner that would not endanger the employees health or safety or the health or safety of others even with reasonable accommodations.
(3)Nothing in this part relating to discrimination on account of marital status shall do either of the following:
(A)Affect the right of an employer to reasonably regulate, for reasons of supervision, safety, security, or morale, the working of spouses in the same department, division, or facility, consistent with the rules and regulations adopted by the council.
(B)Prohibit bona fide health plans from providing additional or greater benefits to employees with dependents than to those employees without or with fewer dependents.
(4)Nothing in this part relating to discrimination on account of sex shall affect the right of an employer to use veteran status as a factor in employee selection or to give special consideration to Vietnam-era veterans.
(5)(A)This part does not prohibit an employer from refusing to employ an individual because of the individuals age if the law compels or provides for that refusal. Promotions within the existing staff, hiring or promotion on the basis of experience and training, rehiring on the basis of seniority and prior service with the employer, or hiring under an established recruiting program from high schools, colleges, universities, or trade schools do not, in and of themselves, constitute unlawful employment practices.
(B)The provisions of this part relating to discrimination on the basis of age do not prohibit an employer from providing health benefits or health care reimbursement plans to retired persons that are altered, reduced, or eliminated when the person becomes eligible for Medicare health benefits. This subparagraph applies to all retiree health benefit plans and contractual provisions or practices concerning retiree health benefits and health care reimbursement plans in effect on or after January 1, 2011.
(b)For a labor organization, because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status of any person, to exclude, expel, or restrict from its membership the person, or to provide only second-class or segregated membership or to discriminate against any person because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status of the person in the election of officers of the labor organization or in the selection of the labor organizations staff or to discriminate in any way against any of its members or against any employer or against any person employed by an employer.
(c)For any person to discriminate against any person in the selection, termination, training, or other terms or treatment of that person in any apprenticeship training program, any other training program leading to employment, an unpaid internship, or another limited duration program to provide unpaid work experience for that person because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status of the person discriminated against.
(d)For any employer or employment agency to print or circulate or cause to be printed or circulated any publication, or to make any nonjob-related inquiry of an employee or applicant, either verbal or through use of an application form, that expresses, directly or indirectly, any limitation, specification, or discrimination as to race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status, or any intent to make any such limitation, specification, or discrimination. This part does not prohibit an employer or employment agency from inquiring into the age of an applicant, or from specifying age limitations, if the law compels or provides for that action.
(e)(1)Except as provided in paragraph (2) or (3), for any employer or employment agency to require any medical or psychological examination of an applicant, to make any medical or psychological inquiry of an applicant, to make any inquiry whether an applicant has a mental disability or physical disability or medical condition, or to make any inquiry regarding the nature or severity of a physical disability, mental disability, or medical condition.
(2)Notwithstanding paragraph (1), an employer or employment agency may inquire into the ability of an applicant to perform job-related functions and may respond to an applicants request for reasonable accommodation.
(3)Notwithstanding paragraph (1), an employer or employment agency may require a medical or psychological examination or make a medical or psychological inquiry of a job applicant after an employment offer has been made but prior to the commencement of employment duties, provided that the examination or inquiry is job related and consistent with business necessity and that all entering employees in the same job classification are subject to the same examination or inquiry.
(f)(1)Except as provided in paragraph (2), for any employer or employment agency to require any medical or psychological examination of an employee, to make any medical or psychological inquiry of an employee, to make any inquiry whether an employee has a mental disability, physical disability, or medical condition, or to make any inquiry regarding the nature or severity of a physical disability, mental disability, or medical condition.
(2)Notwithstanding paragraph (1), an employer or employment agency may require any examinations or inquiries that it can show to be job related and consistent with business necessity. An employer or employment agency may conduct voluntary medical examinations, including voluntary medical histories, which are part of an employee health program available to employees at that worksite.
(g)For any employer, labor organization, or employment agency to harass, discharge, expel, or otherwise discriminate against any person because the person has made a report pursuant to Section 11161.8 of the Penal Code that prohibits retaliation against hospital employees who report suspected patient abuse by health facilities or community care facilities.
(h)For any employer, labor organization, employment agency, or person to discharge, expel, or otherwise discriminate against any person because the person has opposed any practices forbidden under this part or because the person has filed a complaint, testified, or assisted in any proceeding under this part.
(i)For any person to aid, abet, incite, compel, or coerce the doing of any of the acts forbidden under this part, or to attempt to do so.
(j)(1)For an employer, labor organization, employment agency, apprenticeship training program or any training program leading to employment, or any other person, because of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status, to harass an employee, an applicant, an unpaid intern or volunteer, or a person providing services pursuant to a contract. Harassment of an employee, an applicant, an unpaid intern or volunteer, or a person providing services pursuant to a contract by an employee, other than an agent or supervisor, shall be unlawful if the entity, or its agents or supervisors, knows or should have known of this conduct and fails to take immediate and appropriate corrective action. An employer may also be responsible for the acts of nonemployees, with respect to harassment of employees, applicants, unpaid interns or volunteers, or persons providing services pursuant to a contract in the workplace, if the employer, or its agents or supervisors, knows or should have known of the conduct and fails to take immediate and appropriate corrective action. In reviewing cases involving the acts of nonemployees, the extent of the employers control and any other legal responsibility that the employer may have with respect to the conduct of those nonemployees shall be considered. An entity shall take all reasonable steps to prevent harassment from occurring. Loss of tangible job benefits shall not be necessary in order to establish harassment.
(2)The provisions of this subdivision are declaratory of existing law, except for the new duties imposed on employers with regard to harassment.
(3)An employee of an entity subject to this subdivision is personally liable for any harassment prohibited by this section that is perpetrated by the employee, regardless of whether the employer or covered entity knows or should have known of the conduct and fails to take immediate and appropriate corrective action.
(4)(A)For purposes of this subdivision only, employer means any person regularly employing one or more persons or regularly receiving the services of one or more persons providing services pursuant to a contract, or any person acting as an agent of an employer, directly or indirectly, the state, or any political or civil subdivision of the state, and cities. The definition of employer in subdivision (d) of Section 12926 applies to all provisions of this section other than this subdivision.
(B)Notwithstanding subparagraph (A), for purposes of this subdivision, employer does not include a religious association or corporation not organized for private profit, except as provided in Section 12926.2.
(C)For purposes of this subdivision, harassment because of sex includes sexual harassment, gender harassment, and harassment based on pregnancy, childbirth, or related medical conditions. Sexually harassing conduct need not be motivated by sexual desire.
(5)For purposes of this subdivision, a person providing services pursuant to a contract means a person who meets all of the following criteria:
(A)The person has the right to control the performance of the contract for services and discretion as to the manner of performance.
(B)The person is customarily engaged in an independently established business.
(C)The person has control over the time and place the work is performed, supplies the tools and instruments used in the work, and performs work that requires a particular skill not ordinarily used in the course of the employers work.
(k)For an employer, labor organization, employment agency, apprenticeship training program, or any training program leading to employment, to fail to take all reasonable steps necessary to prevent discrimination and harassment from occurring.
(l)(1)For an employer or other entity covered by this part to refuse to hire or employ a person or to refuse to select a person for a training program leading to employment or to bar or to discharge a person from employment or from a training program leading to employment, or to discriminate against a person in compensation or in terms, conditions, or privileges of employment because of a conflict between the persons religious belief or observance and any employment requirement, unless the employer or other entity covered by this part demonstrates that it has explored any available reasonable alternative means of accommodating the religious belief or observance, including the possibilities of excusing the person from those duties that conflict with the persons religious belief or observance or permitting those duties to be performed at another time or by another person, but is unable to reasonably accommodate the religious belief or observance without undue hardship, as defined in subdivision (u) of Section 12926, on the conduct of the business of the employer or other entity covered by this part. Religious belief or observance, as used in this section, includes, but is not limited to, observance of a Sabbath or other religious holy day or days, reasonable time necessary for travel prior and subsequent to a religious observance, and religious dress practice and religious grooming practice as described in subdivision (q) of Section 12926. This subdivision shall also apply to an apprenticeship training program, an unpaid internship, and any other program to provide unpaid experience for a person in the workplace or industry.
(2)An accommodation of an individuals religious dress practice or religious grooming practice is not reasonable if the accommodation requires segregation of the individual from other employees or the public.
(3)An accommodation is not required under this subdivision if it would result in a violation of this part or any other law prohibiting discrimination or protecting civil rights, including subdivision (b) of Section 51 of the Civil Code and Section 11135 of this code.
(4)For an employer or other entity covered by this part to, in addition to the employee protections provided pursuant to subdivision (h), retaliate or otherwise discriminate against a person for requesting accommodation under this subdivision, regardless of whether the request was granted.
(m)(1)For an employer or other entity covered by this part to fail to make reasonable accommodation for the known physical or mental disability of an applicant or employee. Nothing in this subdivision or in paragraph (1) or (2) of subdivision (a) shall be construed to require an accommodation that is demonstrated by the employer or other covered entity to produce undue hardship, as defined in subdivision (u) of Section 12926, to its operation.
(2)For an employer or other entity covered by this part to, in addition to the employee protections provided pursuant to subdivision (h), retaliate or otherwise discriminate against a person for requesting accommodation under this subdivision, regardless of whether the request was granted.
(n)For an employer or other entity covered by this part to fail to engage in a timely, good faith, interactive process with the employee or applicant to determine effective reasonable accommodations, if any, in response to a request for reasonable accommodation by an employee or applicant with a known physical or mental disability or known medical condition.
(o)For an employer or other entity covered by this part, to subject, directly or indirectly, any employee, applicant, or other person to a test for the presence of a genetic characteristic.
(p)For an employer to require, as a condition of employment, continued employment, or a benefit of employment, the disclosure of information relating to an applicants or employees reproductive health decisionmaking.
(q)Nothing in this section shall be interpreted as preventing the ability of employers to identify members of the military or veterans for purposes of awarding a veterans preference as permitted by law.
SEC. 8.Section 12944 of the Government Code, as amended by Section 38 of Chapter 48 of the Statutes of 2022, is amended to read:12944.(a)It shall be unlawful for a licensing board to require any examination or establish any other qualification for licensing that has an adverse impact on any class by virtue of its race, creed, color, national origin or ancestry, sex, gender, gender identity, gender expression, age, medical condition, genetic information, physical disability, mental disability, reproductive health decisionmaking, or sexual orientation, unless the practice can be demonstrated to be job related.
Where the council, after hearing, determines that an examination is unlawful under this subdivision, the licensing board may continue to use and rely on the examination until such time as judicial review by the superior court of the determination is exhausted.
If an examination or other qualification for licensing is determined to be unlawful under this section, that determination shall not void, limit, repeal, or otherwise affect any right, privilege, status, or responsibility previously conferred upon any person by the examination or by a license issued in reliance on the examination or qualification.
(b)It shall be unlawful for a licensing board to fail or refuse to make reasonable accommodation to an individuals mental or physical disability or medical condition.
(c)It shall be unlawful for any licensing board, unless specifically acting in accordance with federal equal employment opportunity guidelines or regulations approved by the council, to print or circulate or cause to be printed or circulated any publication, or to make any non-job-related inquiry, either verbal or through use of an application form, which expresses, directly or indirectly, any limitation, specification, or discrimination as to race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, sex, gender, gender identity, gender expression, age, reproductive health decisionmaking, or sexual orientation or any intent to make any such limitation, specification, or discrimination. Nothing in this subdivision shall prohibit any licensing board from making, in connection with prospective licensure or certification, an inquiry as to, or a request for information regarding, the physical fitness of applicants if that inquiry or request for information is directly related and pertinent to the license or the licensed position the applicant is applying for. Nothing in this subdivision shall prohibit any licensing board, in connection with prospective examinations, licensure, or certification, from inviting individuals with physical or mental disabilities to request reasonable accommodations or from making inquiries related to reasonable accommodations.
(d)It is unlawful for a licensing board to discriminate against any person because the person has filed a complaint, testified, or assisted in any proceeding under this part.
(e)It is unlawful for any licensing board to fail to keep records of applications for licensing or certification for a period of two years following the date of receipt of the applications.
(f)As used in this section, licensing board means any state board, agency, or authority in the Business, Consumer Services, and Housing Agency that has the authority to grant licenses or certificates which are prerequisites to employment eligibility or professional status.
SEC. 9.Section 12993 of the Government Code is amended to read:12993.(a)The provisions of this part shall be construed liberally for the accomplishment of the purposes of this part. This part does not repeal any of the provisions of civil rights law or of any other law of this state relating to discrimination because of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, reproductive health decisionmaking, or sexual orientation, unless those provisions provide less protection to the enumerated classes of persons covered under this part.
(b)The provisions in this part relating to discrimination in employment on account of sex or medical condition do not affect the operation of the terms or conditions of any bona fide retirement, pension, employee benefit, or insurance plan, provided the terms or conditions are in accordance with customary and reasonable or actuarially sound underwriting practices.
(c)While it is the intention of the Legislature to occupy the field of regulation of discrimination in employment and housing encompassed by the provisions of this part, exclusive of all other laws banning discrimination in employment and housing by any city, city and county, county, or other political subdivision of the state, this part does not limit or restrict the application of Section 51 of the Civil Code.
SEC. 10.Section 22853.3 is added to the Government Code, to read:22853.3.Commencing January 1, 2024, a health benefit plan or contract shall provide coverage for contraceptives and related services consistent with the requirements under Section 1367.25 of the Health and Safety Code and Section 10123.196 of the Insurance Code.
SEC. 11.Section 22853.4 is added to the Government Code, to read:22853.4.Commencing January 1, 2024, a health benefit plan or contract shall provide coverage for vasectomies and related services consistent with the requirements under Section 1367.255 of the Health and Safety Code and Section 10123.1945 of the Insurance Code.
SEC. 12.Section 1343 of the Health and Safety Code is amended to read:1343.(a)This chapter shall apply to health care service plans and specialized health care service plan contracts as defined in subdivisions (f) and (o) of Section 1345.
(b)The director may by the adoption of rules or the issuance of orders deemed necessary and appropriate, either unconditionally or upon specified terms and conditions or for specified periods, exempt from this chapter any class of persons or plan contracts if the director finds the action to be in the public interest and not detrimental to the protection of subscribers, enrollees, or persons regulated under this chapter, and that the regulation of the persons or plan contracts is not essential to the purposes of this chapter.
(c)The director, upon request of the Director of Health Care Services, shall exempt from this chapter any county-operated pilot program contracting with the State Department of Health Care Services pursuant to Article 7 (commencing with Section 14490) of Chapter 8 of Part 3 of Division 9 of the Welfare and Institutions Code. The director may exempt noncounty-operated pilot programs upon request of the Director of Health Care Services. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.
(d)Upon the request of the Director of Health Care Services, the director may exempt from this chapter any mental health plan contractor or any capitated rate contract under Chapter 8.9 (commencing with Section 14700) of Part 3 of Division 9 of the Welfare and Institutions Code. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.
(e)This chapter shall not apply to:
(1)A person organized and operating pursuant to a certificate issued by the Insurance Commissioner unless the entity is directly providing the health care service through those entity-owned or contracting health facilities and providers, in which case this chapter shall apply to the insurers plan and to the insurer.
(2)A plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, except that a plan described in this paragraph shall be subject to Section 1367.33.
(3)A person who does all of the following:
(A)Promises to provide care for life or for more than one year in return for a transfer of consideration from, or on behalf of, a person 60 years of age or older.
(B)Has obtained a written license pursuant to Chapter 2 (commencing with Section 1250) or Chapter 3.2 (commencing with Section 1569).
(C)Has obtained a certificate of authority from the State Department of Social Services.
(4)The Major Risk Medical Insurance Board when engaging in activities under Chapter 8 (commencing with Section 10700) of Part 2 of Division 2 of the Insurance Code, Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code, and Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code.
(5)The California Small Group Reinsurance Fund.
SEC. 13.Section 1367.25 of the Health and Safety Code is amended to read:1367.25.(a)A group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, and an individual health care service plan contract that is amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, except for a specialized health care service plan contract, shall provide coverage for the following, under general terms and conditions applicable to all benefits:
(1)A health care service plan contract that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods designated by the plan. In the event the patients participating provider, acting within the providers scope of practice, determines that none of the methods designated by the plan is medically appropriate for the patients medical or personal history, the plan shall also provide coverage for another FDA-approved, medically appropriate prescription contraceptive method prescribed by the patients provider.
(2)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(b)(1)A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for all subscribers and enrollees:
(A)(i)Except as provided in clause (ii) and in subparagraphs (B) and (C) of paragraph (2), all FDA-approved contraceptive drugs, devices, and other products, including all FDA-approved contraceptive drugs, devices, and products available over the counter, as prescribed by the enrollees provider.
(ii)For any health care service plan contract described in paragraph (1) that is issued, amended, renewed, or delivered on or after January 1, 2024, both of the following conditions shall apply:
(I)A prescription shall not be required to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(II)Point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products shall be provided at in-network pharmacies without cost sharing or medical management restrictions.
(B)Voluntary tubal ligation and other similar sterilization procedures.
(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device removal.
(2)(A)Except for a grandfathered health plan, a health care service plan subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision. Cost sharing shall not be imposed on any Medi-Cal beneficiary.
(B)If the FDA has approved one or more therapeutic equivalents, as that term is defined by the FDA, of a contraceptive drug, device, or product, a health care service plan is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutic equivalent generic substitute available in the market, a health care service plan shall provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the enrollees provider, a health care service plan shall defer to the determination and judgment of the provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives, and ability to adhere to the appropriate use of the drug or item, as determined by the provider. The department may promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an enrollee, an enrollees designee, or an enrollees provider to request coverage of an alternative prescribed contraceptive. A request for coverage under this subparagraph that is submitted by an enrollee, an enrollees designee, or provider shall be approved by the health care service plan in compliance with the time limits in Section 1367.241 and, as applicable, with the plans Medi-Cal managed care contract.
(3)Except as otherwise authorized under this section, a health care service plan shall not infringe upon an enrollees choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(5)For purposes of this subdivision, health care service plan shall include Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the benefits described in this subdivision are made the financial responsibility of the Medi-Cal managed care plan under its comprehensive risk contract with the State Department of Health Care Services. If some or all of the benefits described in this subdivision are not the financial responsibility of the Medi-Cal managed care plan, as determined by the State Department of Health Care Services, those benefits shall be available to Medi-Cal beneficiaries on a fee-for-service basis pursuant to subdivision (n) of Section 14132 of the Welfare and Institutions Code.
(c)(1)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for FDA-approved contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(d)(1)Every health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an enrollee by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)This subdivision shall not be construed to require a health care service plan contract to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the plans policies governing out-of-network coverage.
(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health care service plan subject to this subdivision, shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply, and shall not require an enrollee to make any formal request for such coverage other than a pharmacy claim.
(e)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee.
(f)This section shall not be construed to deny or restrict in any way the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(g)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(h)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to health care service plan contracts issued, amended, or renewed on or after January 1, 2016, provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of this code.
(4)For purposes of this section, over-the-counter FDA-approved contraceptive drugs, devices, and products and over-the-counter birth control methods are limited to those included as essential health benefits pursuant to Section 1367.005.
SEC. 14.Section 1367.255 is added to the Health and Safety Code, immediately following Section 1367.25, to read:1367.255.(a)(1)A health care service plan contract issued, amended, renewed, or delivered on or after January 1, 2024, except for a grandfathered health plan or a qualifying health plan for a health savings account, shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy services and procedures. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost sharing for vasectomy services and procedures at the minimum level necessary to preserve the enrollees ability to claim tax-exempt contributions and withdrawals from the enrollees health savings account under Internal Revenue Service laws, regulations, and guidance. Cost sharing shall not be imposed on a Medi-Cal beneficiary.
(2)A health care service plan shall not impose any restrictions or delays, including, but not limited to, prior authorization, on vasectomy services or procedures.
(3)Benefits for an enrollee under this section shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(4)For purposes of this section, health care service plan includes Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the benefits described in this subdivision are made the financial responsibility of the Medi-Cal managed care plan under its comprehensive risk contract with the State Department of Health Care Services. If some or all of the benefits described in this subdivision are not the financial responsibility of the Medi-Cal managed care plan, as determined by the State Department of Health Care Services, those benefits shall be available to Medi-Cal beneficiaries on a fee-for-service basis pursuant to subdivision (n) of Section 14132 of the Welfare and Institutions Code.
(5)Utilization controls applicable to services described in this section provided by a Medi-Cal managed care plan shall be subject to this section.
(b)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for vasectomy services and procedures. The exclusion from coverage under this provision shall not apply to vasectomy services or procedures for purposes other than contraception.
(1)A health care service plan that contracts with a religious employer to provide a health care service plan that does not include coverage and benefits for vasectomy services and procedures shall notify, in writing, upon initial enrollment and annually thereafter upon renewal, each enrollee that vasectomy services and procedures are not included in the enrollees health care service plan.
(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(c)This section shall not be construed to deny or restrict in any way the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(d)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(e)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
SEC. 15.Section 1367.33 is added to the Health and Safety Code, to read:1367.33.Notwithstanding any other law, a plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, and that is issued, amended, renewed, or delivered, on or after January 1, 2024, shall comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255.
SEC. 16.Section 10123.1945 is added to the Insurance Code, immediately following Section 10123.194, to read:10123.1945.(a)(1)A disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, except for a grandfathered health plan or a qualifying health plan for a health savings account, shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy services or procedures. For a qualifying health plan for a health savings account, an insurer shall establish the plans cost sharing for vasectomy services and procedures at the minimum level necessary to preserve the insureds ability to claim tax-exempt contributions and withdrawals from the insureds health savings account under Internal Revenue Service laws, regulations, and guidance.
(2)An insurer shall not impose any restrictions or delays, including, but not limited to, prior authorization, on vasectomy services and procedures.
(3)Coverage with respect to an insured under this section shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)This section shall not be construed to deny or restrict in any way an existing right or benefit provided under law or by contract.
(c)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(d)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for vasectomy services and procedures. The exclusion from coverage under this provision shall not apply to vasectomy services or procedures for purposes other than contraception.
(1)An insurer that contracts with a religious employer to provide a disability insurance policy that does not include coverage and benefits for vasectomy services and procedures shall notify, in writing, upon initial enrollment and annually thereafter upon renewal, each enrollee that vasectomy services and procedures are not included in the insureds disability insurance policy.
(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(e)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(f)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
SEC. 17.Section 10123.196 of the Insurance Code is amended to read:10123.196.(a)An individual or group policy of disability insurance issued, amended, renewed, or delivered on or after January 1, 2000, through December 31, 2015, inclusive, that provides coverage for hospital, medical, or surgical expenses, shall provide coverage for the following, under the same terms and conditions as applicable to all benefits:
(1)A disability insurance policy that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods, as designated by the insurer. If an insureds health care provider determines that none of the methods designated by the disability insurer is medically appropriate for the insureds medical or personal history, the insurer shall, in the alternative, provide coverage for some other FDA-approved prescription contraceptive method prescribed by the patients health care provider.
(2)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for all policyholders and insureds:
(A)(i)Except as provided in clause (ii) and in subparagraphs (B) and (C) of paragraph (2), all FDA-approved, contraceptive drugs, devices, and other products, including all FDA-approved, contraceptive drugs, devices, and products available over the counter, as prescribed by the insureds provider.
(ii)For any policy described in paragraph (1) that is issued, amended, renewed, or delivered on or after January 1, 2024, both of the following conditions shall apply:
(I)A prescription shall not be required to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(II)Point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products shall be provided at in-network pharmacies without cost sharing or medical management restrictions.
(B)Voluntary tubal ligation and other similar sterilization procedures.
(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device removal.
(2)(A)Except for a grandfathered health plan, a disability insurer subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision.
(B)If the FDA has approved one or more therapeutic equivalents, as that term is defined by the FDA, of a contraceptive drug, device, or product, a disability insurer is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, an insurer shall provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the insureds provider, a disability insurer shall defer to the determination and judgment of the provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives, and ability to adhere to the appropriate use of the drug or item, as determined by the provider. The department may promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an insured, an insureds designee, or an insureds provider to request coverage of an alternative prescribed contraceptive. A request for coverage under this subparagraph that is submitted by an insured, an insureds designee, or a provider shall be approved by the disability insurer in compliance with the time limits in Section 10123.191.
(3)Except as otherwise authorized under this section, an insurer shall not infringe upon an insureds choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(c)This section shall not be construed to deny or restrict in any way any existing right or benefit provided under law or by contract.
(d)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(e)(1)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(f)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an insured by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)This subdivision shall not be construed to require a policy to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the insurers policies governing out-of-network coverage.
(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)An insurer subject to this subdivision shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply, and shall not require an insured to make any formal request for such coverage other than a pharmacy claim.
(g)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an insured.
(h)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(i)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to policies of disability insurance issued, amended, or renewed on or after January 1, 2016, health care provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
(4)For purposes of this section, over-the-counter FDA-approved contraceptive drugs, devices, and products and over-the-counter birth control methods are limited to those included as essential health benefits pursuant to Section 10112.27.
SEC. 18.Section 10127.09 is added to the Insurance Code, to read:10127.09.Notwithstanding any other law, a disability insurance policy that provides hospital, medical, surgical, prescription drug, or nursing benefits, except a policy providing only dental or vision benefits, that is issued, amended, renewed, or delivered, on or after January 1, 2024, and that is issued to a bona fide public or private institution of higher learning and provides coverage to its students and their dependents, or to its faculty, staff, administration, and their respective dependents, shall comply with the coverage requirements of Sections 10123.1945 and 10123.196.
SEC. 19.Section 10509.5 is added to the Public Contract Code, to read:10509.5.Notwithstanding any other law, commencing January 1, 2024, the University of California shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255 of the Health and Safety Code Sections 10123.1945 and 10123.196 of the Insurance Code.
SEC. 20.Section 10828 is added to the Public Contract Code, to read:10828.Notwithstanding any other law, commencing January 1, 2024, the California State University shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255 of the Health and Safety Code, and Sections 10123.1945 and 10123.196 of the Insurance Code.
SEC. 21.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
SEC. 22.Section 5.5 of this bill incorporates amendments to Section 12926 of the Government Code proposed by both this bill and Assembly Bill 1766. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2023, (2) each bill amends Section 12926 of the Government Code, and (3) this bill is enacted after Assembly Bill 1766, in which case Section 5 of this bill shall not become operative.
SEC. 23.Section 6.5 of this bill incorporates amendments to Section 12931 of the Government Code proposed by both this bill and Assembly Bill 2960. That section shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2023, (2) each bill amends Section 12931 of the Government Code, and (3) this bill is enacted after Assembly Bill 2960, in which case Section 6 of this bill shall not become operative.
This act shall be known, and may be cited, as the Contraceptive Equity Act of 2022.
SEC. 2.The Legislature finds and declares all of the following:
(a)California has a long history of expanding timely access to birth control to prevent unintended pregnancy. Thanks to a combination of innovative policies and programs enacted statewide, unintended pregnancy rates are at a 30-year low.
(b)Despite the progress made, health disparities in reproductive health outcomes persist among Black, Indigenous and People of Color, including disproportionate unintended pregnancy, infant and maternal mortality, and sexually transmitted infection rates. The Legislature must take action to ensure that all Californians have equitable access to preventive contraceptive care.
(c)The federal Patient Protection and Affordable Care Act (Public Law 111-148) included a mandate that most health insurance plans cover contraception without out-of-pocket costs for patients.
(d)Californias Contraceptive Coverage Equity Act of 2014 and the Annual Supply of Contraceptives Act of 2016, built on this federal policy and existing state law to be the first state in the country to require coverage of birth control methods approved by the federal Food and Drug Administration for women without cost sharing or restrictions and a 12-month supply of self-administered birth control dispensed at one time for individuals enrolled in health insurance plans and policies regulated by the Knox-Keene Health Care Service Plan Act of 1975.
(e)Since 2014, several other states have expanded on Californias model legislation to create more equitable contraceptive coverage and access by requiring most health insurance plans and policies to cover voluntary sterilization services and all birth control methods available over-the-counter without a prescription for all beneficiaries, regardless of gender.
(f)A report by the Guttmacher Institute shows that vasectomy is among the most effective and cost-effective contraceptive methods available.
(g)Trump-era attacks on birth control access have underscored the need to codify the expansion of contraceptive coverage for as many Californians as possible under state law.
(h)The COVID-19 public health emergency has also further illuminated the structural inequities that disproportionately affect youth, low-income people and communities of color in accessing birth control services. A report by the Guttmacher Institute revealed that 29 percent of White women, 38 percent of Black women and 45 percent of Latinas now face difficulties accessing birth control as a result of the pandemic.
(i)The Legislature intends to reduce sexual and reproductive health disparities and ensure greater health equity by providing a pathway for more Californians to get the contraceptive care they want, when they need it without inequitable delays or cost barriers.
(j)The Legislature intends for the relevant California departments and agencies to work in concert to ensure compliance with these provisions.
SEC. 3.Section 12920 of the Government Code is amended to read:12920.It is hereby declared as the public policy of this state that it is necessary to protect and safeguard the right and opportunity of all persons to seek, obtain, and hold employment without discrimination or abridgment on account of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or military and veteran status.
It is recognized that the practice of denying employment opportunity and discriminating in the terms of employment for these reasons foments domestic strife and unrest, deprives the state of the fullest utilization of its capacities for development and advancement, and substantially and adversely affects the interests of employees, employers, and the public in general.
Further, the practice of discrimination because of race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, familial status, source of income, disability, veteran or military status, or genetic information in housing accommodations is declared to be against public policy.
It is the purpose of this part to provide effective remedies that will eliminate these discriminatory practices.
This part shall be deemed an exercise of the police power of the state for the protection of the welfare, health, and peace of the people of this state.
SEC. 4.Section 12921 of the Government Code is amended to read:12921.(a)The opportunity to seek, obtain, and hold employment without discrimination because of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status is hereby recognized as and declared to be a civil right.
(b)The opportunity to seek, obtain, and hold housing without discrimination because of race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, familial status, source of income, disability, veteran or military status, genetic information, or any other basis prohibited by Section 51 of the Civil Code is hereby recognized as and declared to be a civil right.
SEC. 5.Section 12926 of the Government Code is amended to read:12926.As used in this part in connection with unlawful practices, unless a different meaning clearly appears from the context:
(a)Affirmative relief or prospective relief includes the authority to order reinstatement of an employee, awards of backpay, reimbursement of out-of-pocket expenses, hiring, transfers, reassignments, grants of tenure, promotions, cease and desist orders, posting of notices, training of personnel, testing, expunging of records, reporting of records, and any other similar relief that is intended to correct unlawful practices under this part.
(b)Age refers to the chronological age of any individual who has reached a 40th birthday.
(c)Except as provided by Section 12926.05, employee does not include any individual employed by that persons parent, spouse, or child or any individual employed under a special license in a nonprofit sheltered workshop or rehabilitation facility.
(d)Employer includes any person regularly employing five or more persons, or any person acting as an agent of an employer, directly or indirectly, the state or any political or civil subdivision of the state, and cities, except as follows:
Employer does not include a religious association or corporation not organized for private profit.
(e)Employment agency includes any person undertaking for compensation to procure employees or opportunities to work.
(f)Essential functions means the fundamental job duties of the employment position the individual with a disability holds or desires. Essential functions does not include the marginal functions of the position.
(1)A job function may be considered essential for any of several reasons, including, but not limited to, any one or more of the following:
(A)The function may be essential because the reason the position exists is to perform that function.
(B)The function may be essential because of the limited number of employees available among whom the performance of that job function can be distributed.
(C)The function may be highly specialized, so that the incumbent in the position is hired based on expertise or the ability to perform a particular function.
(2)Evidence of whether a particular function is essential includes, but is not limited to, the following:
(A)The employers judgment as to which functions are essential.
(B)Written job descriptions prepared before advertising or interviewing applicants for the job.
(C)The amount of time spent on the job performing the function.
(D)The consequences of not requiring the incumbent to perform the function.
(E)The terms of a collective bargaining agreement.
(F)The work experiences of past incumbents in the job.
(G)The current work experience of incumbents in similar jobs.
(g)(1)Genetic information means, with respect to any individual, information about any of the following:
(A)The individuals genetic tests.
(B)The genetic tests of family members of the individual.
(C)The manifestation of a disease or disorder in family members of the individual.
(2)Genetic information includes any request for, or receipt of, genetic services, or participation in clinical research that includes genetic services, by an individual or any family member of the individual.
(3)Genetic information does not include information about the sex or age of any individual.
(h)Labor organization includes any organization that exists and is constituted for the purpose, in whole or in part, of collective bargaining or of dealing with employers concerning grievances, terms or conditions of employment, or of other mutual aid or protection.
(i)Medical condition means either of the following:
(1)Any health impairment related to or associated with a diagnosis of cancer or a record or history of cancer.
(2)Genetic characteristics. For purposes of this section, genetic characteristics means either of the following:
(A)Any scientifically or medically identifiable gene or chromosome, or combination or alteration thereof, that is known to be a cause of a disease or disorder in a person or that persons offspring, or that is determined to be associated with a statistically increased risk of development of a disease or disorder, and that is presently not associated with any symptoms of any disease or disorder.
(B)Inherited characteristics that may derive from the individual or family member, that are known to be a cause of a disease or disorder in a person or that persons offspring, or that are determined to be associated with a statistically increased risk of development of a disease or disorder, and that are presently not associated with any symptoms of any disease or disorder.
(j)Mental disability includes, but is not limited to, all of the following:
(1)Having any mental or psychological disorder or condition, such as intellectual disability, organic brain syndrome, emotional or mental illness, or specific learning disabilities, that limits a major life activity. For purposes of this section:
(A)Limits shall be determined without regard to mitigating measures, such as medications, assistive devices, or reasonable accommodations, unless the mitigating measure itself limits a major life activity.
(B)A mental or psychological disorder or condition limits a major life activity if it makes the achievement of the major life activity difficult.
(C)Major life activities shall be broadly construed and shall include physical, mental, and social activities and working.
(2)Any other mental or psychological disorder or condition not described in paragraph (1) that requires special education or related services.
(3)Having a record or history of a mental or psychological disorder or condition described in paragraph (1) or (2), which is known to the employer or other entity covered by this part.
(4)Being regarded or treated by the employer or other entity covered by this part as having, or having had, any mental condition that makes achievement of a major life activity difficult.
(5)Being regarded or treated by the employer or other entity covered by this part as having, or having had, a mental or psychological disorder or condition that has no present disabling effect, but that may become a mental disability as described in paragraph (1) or (2).
Mental disability does not include sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from the current unlawful use of controlled substances or other drugs.
(k)Veteran or military status means a member or veteran of the United States Armed Forces, United States Armed Forces Reserve, the United States National Guard, and the California National Guard.
(l)On the bases enumerated in this part means or refers to discrimination on the basis of one or more of the following: race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, sexual orientation, reproductive health decisionmaking, or veteran or military status.
(m)Physical disability includes, but is not limited to, all of the following:
(1)Having any physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss that does both of the following:
(A)Affects one or more of the following body systems: neurological, immunological, musculoskeletal, special sense organs, respiratory, including speech organs, cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine.
(B)Limits a major life activity. For purposes of this section:
(i)Limits shall be determined without regard to mitigating measures such as medications, assistive devices, prosthetics, or reasonable accommodations, unless the mitigating measure itself limits a major life activity.
(ii)A physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss limits a major life activity if it makes the achievement of the major life activity difficult.
(iii)Major life activities shall be broadly construed and includes physical, mental, and social activities and working.
(2)Any other health impairment not described in paragraph (1) that requires special education or related services.
(3)Having a record or history of a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment described in paragraph (1) or (2), which is known to the employer or other entity covered by this part.
(4)Being regarded or treated by the employer or other entity covered by this part as having, or having had, any physical condition that makes achievement of a major life activity difficult.
(5)Being regarded or treated by the employer or other entity covered by this part as having, or having had, a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment that has no present disabling effect but may become a physical disability as described in paragraph (1) or (2).
(6)Physical disability does not include sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from the current unlawful use of controlled substances or other drugs.
(n)Notwithstanding subdivisions (j) and (m), if the definition of disability used in the federal Americans with Disabilities Act of 1990 (Public Law 101-336) would result in broader protection of the civil rights of individuals with a mental disability or physical disability, as defined in subdivision (j) or (m), or would include any medical condition not included within those definitions, then that broader protection or coverage shall be deemed incorporated by reference into, and shall prevail over conflicting provisions of, the definitions in subdivisions (j) and (m).
(o)Race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, sexual orientation, reproductive health decisionmaking, or veteran or military status includes a perception that the person has any of those characteristics or that the person is associated with a person who has, or is perceived to have, any of those characteristics.
(p)Reasonable accommodation may include either of the following:
(1)Making existing facilities used by employees readily accessible to, and usable by, individuals with disabilities.
(2)Job restructuring, part-time or modified work schedules, reassignment to a vacant position, acquisition or modification of equipment or devices, adjustment or modifications of examinations, training materials or policies, the provision of qualified readers or interpreters, and other similar accommodations for individuals with disabilities.
(q)Religious creed, religion, religious observance, religious belief, and creed include all aspects of religious belief, observance, and practice, including religious dress and grooming practices. Religious dress practice shall be construed broadly to include the wearing or carrying of religious clothing, head or face coverings, jewelry, artifacts, and any other item that is part of an individual observing a religious creed. Religious grooming practice shall be construed broadly to include all forms of head, facial, and body hair that are part of an individual observing a religious creed.
(r)(1)Sex includes, but is not limited to, the following:
(A)Pregnancy or medical conditions related to pregnancy.
(B)Childbirth or medical conditions related to childbirth.
(C)Breastfeeding or medical conditions related to breastfeeding.
(2)Sex also includes, but is not limited to, a persons gender. Gender means sex, and includes a persons gender identity and gender expression. Gender expression means a persons gender-related appearance and behavior whether or not stereotypically associated with the persons assigned sex at birth.
(s)Sexual orientation means heterosexuality, homosexuality, and bisexuality.
(t)Supervisor means any individual having the authority, in the interest of the employer, to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline other employees, or the responsibility to direct them, or to adjust their grievances, or effectively to recommend that action, if, in connection with the foregoing, the exercise of that authority is not of a merely routine or clerical nature, but requires the use of independent judgment.
(u)Undue hardship means an action requiring significant difficulty or expense, when considered in light of the following factors:
(1)The nature and cost of the accommodation needed.
(2)The overall financial resources of the facilities involved in the provision of the reasonable accommodations, the number of persons employed at the facility, and the effect on expenses and resources or the impact otherwise of these accommodations upon the operation of the facility.
(3)The overall financial resources of the covered entity, the overall size of the business of a covered entity with respect to the number of employees, and the number, type, and location of its facilities.
(4)The type of operations, including the composition, structure, and functions of the workforce of the entity.
(5)The geographic separateness or administrative or fiscal relationship of the facility or facilities.
(v)National origin discrimination includes, but is not limited to, discrimination on the basis of possessing a drivers license granted under Section 12801.9 of the Vehicle Code.
(w)Race is inclusive of traits historically associated with race, including, but not limited to, hair texture and protective hairstyles.
(x)Protective hairstyles includes, but is not limited to, such hairstyles as braids, locks, and twists.
(y)Reproductive health decisionmaking includes, but is not limited to, a decision to use or access a particular drug, device, product, or medical service for reproductive health. This subdivision and other provisions in this part relating to reproductive health decisionmaking shall not be construed to mean that subdivision (r) of this section and other provisions in this part related to sex do not include reproductive health decisionmaking.
SEC. 5.5.Section 12926 of the Government Code is amended to read:12926.As used in this part in connection with unlawful practices, unless a different meaning clearly appears from the context:
(a)Affirmative relief or prospective relief includes the authority to order reinstatement of an employee, awards of backpay, reimbursement of out-of-pocket expenses, hiring, transfers, reassignments, grants of tenure, promotions, cease and desist orders, posting of notices, training of personnel, testing, expunging of records, reporting of records, and any other similar relief that is intended to correct unlawful practices under this part.
(b)Age refers to the chronological age of any individual who has reached a 40th birthday.
(c)Except as provided by Section 12926.05, employee does not include any individual employed by that persons parent, spouse, or child or any individual employed under a special license in a nonprofit sheltered workshop or rehabilitation facility.
(d)Employer includes any person regularly employing five or more persons, or any person acting as an agent of an employer, directly or indirectly, the state or any political or civil subdivision of the state, and cities, except as follows:
Employer does not include a religious association or corporation not organized for private profit.
(e)Employment agency includes any person undertaking for compensation to procure employees or opportunities to work.
(f)Essential functions means the fundamental job duties of the employment position the individual with a disability holds or desires. Essential functions does not include the marginal functions of the position.
(1)A job function may be considered essential for any of several reasons, including, but not limited to, any one or more of the following:
(A)The function may be essential because the reason the position exists is to perform that function.
(B)The function may be essential because of the limited number of employees available among whom the performance of that job function can be distributed.
(C)The function may be highly specialized, so that the incumbent in the position is hired based on expertise or the ability to perform a particular function.
(2)Evidence of whether a particular function is essential includes, but is not limited to, the following:
(A)The employers judgment as to which functions are essential.
(B)Written job descriptions prepared before advertising or interviewing applicants for the job.
(C)The amount of time spent on the job performing the function.
(D)The consequences of not requiring the incumbent to perform the function.
(E)The terms of a collective bargaining agreement.
(F)The work experiences of past incumbents in the job.
(G)The current work experience of incumbents in similar jobs.
(g)(1)Genetic information means, with respect to any individual, information about any of the following:
(A)The individuals genetic tests.
(B)The genetic tests of family members of the individual.
(C)The manifestation of a disease or disorder in family members of the individual.
(2)Genetic information includes any request for, or receipt of, genetic services, or participation in clinical research that includes genetic services, by an individual or any family member of the individual.
(3)Genetic information does not include information about the sex or age of any individual.
(h)Labor organization includes any organization that exists and is constituted for the purpose, in whole or in part, of collective bargaining or of dealing with employers concerning grievances, terms or conditions of employment, or of other mutual aid or protection.
(i)Medical condition means either of the following:
(1)Any health impairment related to or associated with a diagnosis of cancer or a record or history of cancer.
(2)Genetic characteristics. For purposes of this section, genetic characteristics means either of the following:
(A)Any scientifically or medically identifiable gene or chromosome, or combination or alteration thereof, that is known to be a cause of a disease or disorder in a person or that persons offspring, or that is determined to be associated with a statistically increased risk of development of a disease or disorder, and that is presently not associated with any symptoms of any disease or disorder.
(B)Inherited characteristics that may derive from the individual or family member, that are known to be a cause of a disease or disorder in a person or that persons offspring, or that are determined to be associated with a statistically increased risk of development of a disease or disorder, and that are presently not associated with any symptoms of any disease or disorder.
(j)Mental disability includes, but is not limited to, all of the following:
(1)Having any mental or psychological disorder or condition, such as intellectual disability, organic brain syndrome, emotional or mental illness, or specific learning disabilities, that limits a major life activity. For purposes of this section:
(A)Limits shall be determined without regard to mitigating measures, such as medications, assistive devices, or reasonable accommodations, unless the mitigating measure itself limits a major life activity.
(B)A mental or psychological disorder or condition limits a major life activity if it makes the achievement of the major life activity difficult.
(C)Major life activities shall be broadly construed and shall include physical, mental, and social activities and working.
(2)Any other mental or psychological disorder or condition not described in paragraph (1) that requires special education or related services.
(3)Having a record or history of a mental or psychological disorder or condition described in paragraph (1) or (2), which is known to the employer or other entity covered by this part.
(4)Being regarded or treated by the employer or other entity covered by this part as having, or having had, any mental condition that makes achievement of a major life activity difficult.
(5)Being regarded or treated by the employer or other entity covered by this part as having, or having had, a mental or psychological disorder or condition that has no present disabling effect, but that may become a mental disability as described in paragraph (1) or (2).
Mental disability does not include sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from the current unlawful use of controlled substances or other drugs.
(k)Veteran or military status means a member or veteran of the United States Armed Forces, United States Armed Forces Reserve, the United States National Guard, and the California National Guard.
(l)On the bases enumerated in this part means or refers to discrimination on the basis of one or more of the following: race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, sexual orientation, reproductive health decisionmaking, or veteran or military status.
(m)Physical disability includes, but is not limited to, all of the following:
(1)Having any physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss that does both of the following:
(A)Affects one or more of the following body systems: neurological, immunological, musculoskeletal, special sense organs, respiratory, including speech organs, cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine.
(B)Limits a major life activity. For purposes of this section:
(i)Limits shall be determined without regard to mitigating measures such as medications, assistive devices, prosthetics, or reasonable accommodations, unless the mitigating measure itself limits a major life activity.
(ii)A physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss limits a major life activity if it makes the achievement of the major life activity difficult.
(iii)Major life activities shall be broadly construed and includes physical, mental, and social activities and working.
(2)Any other health impairment not described in paragraph (1) that requires special education or related services.
(3)Having a record or history of a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment described in paragraph (1) or (2), which is known to the employer or other entity covered by this part.
(4)Being regarded or treated by the employer or other entity covered by this part as having, or having had, any physical condition that makes achievement of a major life activity difficult.
(5)Being regarded or treated by the employer or other entity covered by this part as having, or having had, a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment that has no present disabling effect but may become a physical disability as described in paragraph (1) or (2).
(6)Physical disability does not include sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from the current unlawful use of controlled substances or other drugs.
(n)Notwithstanding subdivisions (j) and (m), if the definition of disability used in the federal Americans with Disabilities Act of 1990 (Public Law 101-336) would result in broader protection of the civil rights of individuals with a mental disability or physical disability, as defined in subdivision (j) or (m), or would include any medical condition not included within those definitions, then that broader protection or coverage shall be deemed incorporated by reference into, and shall prevail over conflicting provisions of, the definitions in subdivisions (j) and (m).
(o)Race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, sexual orientation, reproductive health decisionmaking, or veteran or military status includes a perception that the person has any of those characteristics or that the person is associated with a person who has, or is perceived to have, any of those characteristics.
(p)Reasonable accommodation may include either of the following:
(1)Making existing facilities used by employees readily accessible to, and usable by, individuals with disabilities.
(2)Job restructuring, part-time or modified work schedules, reassignment to a vacant position, acquisition or modification of equipment or devices, adjustment or modifications of examinations, training materials or policies, the provision of qualified readers or interpreters, and other similar accommodations for individuals with disabilities.
(q)Religious creed, religion, religious observance, religious belief, and creed include all aspects of religious belief, observance, and practice, including religious dress and grooming practices. Religious dress practice shall be construed broadly to include the wearing or carrying of religious clothing, head or face coverings, jewelry, artifacts, and any other item that is part of an individual observing a religious creed. Religious grooming practice shall be construed broadly to include all forms of head, facial, and body hair that are part of an individual observing a religious creed.
(r)(1)Sex includes, but is not limited to, the following:
(A)Pregnancy or medical conditions related to pregnancy.
(B)Childbirth or medical conditions related to childbirth.
(C)Breastfeeding or medical conditions related to breastfeeding.
(2)Sex also includes, but is not limited to, a persons gender. Gender means sex, and includes a persons gender identity and gender expression. Gender expression means a persons gender-related appearance and behavior whether or not stereotypically associated with the persons assigned sex at birth.
(s)Sexual orientation means heterosexuality, homosexuality, and bisexuality.
(t)Supervisor means any individual having the authority, in the interest of the employer, to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline other employees, or the responsibility to direct them, or to adjust their grievances, or effectively to recommend that action, if, in connection with the foregoing, the exercise of that authority is not of a merely routine or clerical nature, but requires the use of independent judgment.
(u)Undue hardship means an action requiring significant difficulty or expense, when considered in light of the following factors:
(1)The nature and cost of the accommodation needed.
(2)The overall financial resources of the facilities involved in the provision of the reasonable accommodations, the number of persons employed at the facility, and the effect on expenses and resources or the impact otherwise of these accommodations upon the operation of the facility.
(3)The overall financial resources of the covered entity, the overall size of the business of a covered entity with respect to the number of employees, and the number, type, and location of its facilities.
(4)The type of operations, including the composition, structure, and functions of the workforce of the entity.
(5)The geographic separateness or administrative or fiscal relationship of the facility or facilities.
(v)National origin discrimination includes, but is not limited to, discrimination on the basis of possessing a drivers license or identification card granted under Section 12801.9 of the Vehicle Code.
(w)Race is inclusive of traits historically associated with race, including, but not limited to, hair texture and protective hairstyles.
(x)Protective hairstyles includes, but is not limited to, such hairstyles as braids, locks, and twists.
(y)Reproductive health decisionmaking includes, but is not limited to, a decision to use or access a particular drug, device, product, or medical service for reproductive health. This subdivision and other provisions in this part relating to reproductive health decisionmaking shall not be construed to mean that subdivision (r) of this section and other provisions in this part related to sex do not include reproductive health decisionmaking.
SEC. 6.Section 12931 of the Government Code is amended to read:12931.The department may also provide assistance to communities and persons therein in resolving disputes, disagreements, or difficulties relating to discriminatory practices based on race, religious creed, color, national origin, ancestry, physical disability, mental disability, veteran or military status, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, familial status, age, reproductive health decisionmaking, or sexual orientation that impair the rights of persons in those communities under the Constitution or laws of the United States or of this state. The services of the department may be made available in cases of these disputes, disagreements, or difficulties only when, in its judgment, peaceful relations among the citizens of the community involved are threatened thereby. The departments services are to be made available only upon the request of an appropriate state or local public body, or upon the request of any person directly affected by any such dispute, disagreement, or difficulty.
The assistance of the department pursuant to this section shall be limited to endeavors at investigation, conference, conciliation, and persuasion.
SEC. 6.5.Section 12931 of the Government Code is amended to read:12931.The department may also provide assistance to communities and persons therein in resolving disputes, disagreements, or difficulties relating to discriminatory practices based on race, religious creed, color, national origin, ancestry, physical disability, mental disability, veteran or military status, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, familial status, age, reproductive health decisionmaking, or sexual orientation that impair the rights of persons in those communities under the Constitution or laws of the United States or of this state. The services of the department may be made available in cases of these disputes, disagreements, or difficulties only when, in its judgment, peaceful relations among the persons of the community involved are threatened thereby. The departments services are to be made available only upon the request of an appropriate state or local public body, or upon the request of any person directly affected by the dispute, disagreement, or difficulty.
The assistance of the department pursuant to this section shall be limited to endeavors at investigation, conference, conciliation, and persuasion.
SEC. 7.Section 12940 of the Government Code, as amended by Section 36 of Chapter 48 of the Statutes of 2022, is amended to read:12940.It is an unlawful employment practice, unless based upon a bona fide occupational qualification, or, except where based upon applicable security regulations established by the United States or the State of California:
(a)For an employer, because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decisionmaking, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, or veteran or military status of any person, to refuse to hire or employ the person or to refuse to select the person for a training program leading to employment, or to bar or to discharge the person from employment or from a training program leading to employment, or to discriminate against the person in compensation or in terms, conditions, or privileges of employment.
(1)This part does not prohibit an employer from refusing to hire or discharging an employee with a physical or mental disability, or subject an employer to any legal liability resulting from the refusal to employ or the discharge of an employee with a physical or mental disability, if the employee, because of a physical or mental disability, is unable to perform the employees essential duties even with reasonable accommodations, or cannot perform those duties in a manner that would not endanger the employees health or safety or the health or safety of others even with reasonable accommodations.
(2)This part does not prohibit an employer from refusing to hire or discharging an employee who, because of the employees medical condition, is unable to perform the employees essential duties even with reasonable accommodations, or cannot perform those duties in a manner that would not endanger the employees health or safety or the health or safety of others even with reasonable accommodations. Nothing in this part shall subject an employer to any legal liability resulting from the refusal to employ or the discharge of an employee who, because of the employees medical condition, is unable to perform the employees essential duties, or cannot perform those duties in a manner that would not endanger the employees health or safety or the health or safety of others even with reasonable accommodations.
(3)Nothing in this part relating to discrimination on account of marital status shall do either of the following:
(A)Affect the right of an employer to reasonably regulate, for reasons of supervision, safety, security, or morale, the working of spouses in the same department, division, or facility, consistent with the rules and regulations adopted by the council.
(B)Prohibit bona fide health plans from providing additional or greater benefits to employees with dependents than to those employees without or with fewer dependents.
(4)Nothing in this part relating to discrimination on account of sex shall affect the right of an employer to use veteran status as a factor in employee selection or to give special consideration to Vietnam-era veterans.
(5)(A)This part does not prohibit an employer from refusing to employ an individual because of the individuals age if the law compels or provides for that refusal. Promotions within the existing staff, hiring or promotion on the basis of experience and training, rehiring on the basis of seniority and prior service with the employer, or hiring under an established recruiting program from high schools, colleges, universities, or trade schools do not, in and of themselves, constitute unlawful employment practices.
(B)The provisions of this part relating to discrimination on the basis of age do not prohibit an employer from providing health benefits or health care reimbursement plans to retired persons that are altered, reduced, or eliminated when the person becomes eligible for Medicare health benefits. This subparagraph applies to all retiree health benefit plans and contractual provisions or practices concerning retiree health benefits and health care reimbursement plans in effect on or after January 1, 2011.
(b)For a labor organization, because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status of any person, to exclude, expel, or restrict from its membership the person, or to provide only second-class or segregated membership or to discriminate against any person because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status of the person in the election of officers of the labor organization or in the selection of the labor organizations staff or to discriminate in any way against any of its members or against any employer or against any person employed by an employer.
(c)For any person to discriminate against any person in the selection, termination, training, or other terms or treatment of that person in any apprenticeship training program, any other training program leading to employment, an unpaid internship, or another limited duration program to provide unpaid work experience for that person because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status of the person discriminated against.
(d)For any employer or employment agency to print or circulate or cause to be printed or circulated any publication, or to make any nonjob-related inquiry of an employee or applicant, either verbal or through use of an application form, that expresses, directly or indirectly, any limitation, specification, or discrimination as to race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status, or any intent to make any such limitation, specification, or discrimination. This part does not prohibit an employer or employment agency from inquiring into the age of an applicant, or from specifying age limitations, if the law compels or provides for that action.
(e)(1)Except as provided in paragraph (2) or (3), for any employer or employment agency to require any medical or psychological examination of an applicant, to make any medical or psychological inquiry of an applicant, to make any inquiry whether an applicant has a mental disability or physical disability or medical condition, or to make any inquiry regarding the nature or severity of a physical disability, mental disability, or medical condition.
(2)Notwithstanding paragraph (1), an employer or employment agency may inquire into the ability of an applicant to perform job-related functions and may respond to an applicants request for reasonable accommodation.
(3)Notwithstanding paragraph (1), an employer or employment agency may require a medical or psychological examination or make a medical or psychological inquiry of a job applicant after an employment offer has been made but prior to the commencement of employment duties, provided that the examination or inquiry is job related and consistent with business necessity and that all entering employees in the same job classification are subject to the same examination or inquiry.
(f)(1)Except as provided in paragraph (2), for any employer or employment agency to require any medical or psychological examination of an employee, to make any medical or psychological inquiry of an employee, to make any inquiry whether an employee has a mental disability, physical disability, or medical condition, or to make any inquiry regarding the nature or severity of a physical disability, mental disability, or medical condition.
(2)Notwithstanding paragraph (1), an employer or employment agency may require any examinations or inquiries that it can show to be job related and consistent with business necessity. An employer or employment agency may conduct voluntary medical examinations, including voluntary medical histories, which are part of an employee health program available to employees at that worksite.
(g)For any employer, labor organization, or employment agency to harass, discharge, expel, or otherwise discriminate against any person because the person has made a report pursuant to Section 11161.8 of the Penal Code that prohibits retaliation against hospital employees who report suspected patient abuse by health facilities or community care facilities.
(h)For any employer, labor organization, employment agency, or person to discharge, expel, or otherwise discriminate against any person because the person has opposed any practices forbidden under this part or because the person has filed a complaint, testified, or assisted in any proceeding under this part.
(i)For any person to aid, abet, incite, compel, or coerce the doing of any of the acts forbidden under this part, or to attempt to do so.
(j)(1)For an employer, labor organization, employment agency, apprenticeship training program or any training program leading to employment, or any other person, because of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status, to harass an employee, an applicant, an unpaid intern or volunteer, or a person providing services pursuant to a contract. Harassment of an employee, an applicant, an unpaid intern or volunteer, or a person providing services pursuant to a contract by an employee, other than an agent or supervisor, shall be unlawful if the entity, or its agents or supervisors, knows or should have known of this conduct and fails to take immediate and appropriate corrective action. An employer may also be responsible for the acts of nonemployees, with respect to harassment of employees, applicants, unpaid interns or volunteers, or persons providing services pursuant to a contract in the workplace, if the employer, or its agents or supervisors, knows or should have known of the conduct and fails to take immediate and appropriate corrective action. In reviewing cases involving the acts of nonemployees, the extent of the employers control and any other legal responsibility that the employer may have with respect to the conduct of those nonemployees shall be considered. An entity shall take all reasonable steps to prevent harassment from occurring. Loss of tangible job benefits shall not be necessary in order to establish harassment.
(2)The provisions of this subdivision are declaratory of existing law, except for the new duties imposed on employers with regard to harassment.
(3)An employee of an entity subject to this subdivision is personally liable for any harassment prohibited by this section that is perpetrated by the employee, regardless of whether the employer or covered entity knows or should have known of the conduct and fails to take immediate and appropriate corrective action.
(4)(A)For purposes of this subdivision only, employer means any person regularly employing one or more persons or regularly receiving the services of one or more persons providing services pursuant to a contract, or any person acting as an agent of an employer, directly or indirectly, the state, or any political or civil subdivision of the state, and cities. The definition of employer in subdivision (d) of Section 12926 applies to all provisions of this section other than this subdivision.
(B)Notwithstanding subparagraph (A), for purposes of this subdivision, employer does not include a religious association or corporation not organized for private profit, except as provided in Section 12926.2.
(C)For purposes of this subdivision, harassment because of sex includes sexual harassment, gender harassment, and harassment based on pregnancy, childbirth, or related medical conditions. Sexually harassing conduct need not be motivated by sexual desire.
(5)For purposes of this subdivision, a person providing services pursuant to a contract means a person who meets all of the following criteria:
(A)The person has the right to control the performance of the contract for services and discretion as to the manner of performance.
(B)The person is customarily engaged in an independently established business.
(C)The person has control over the time and place the work is performed, supplies the tools and instruments used in the work, and performs work that requires a particular skill not ordinarily used in the course of the employers work.
(k)For an employer, labor organization, employment agency, apprenticeship training program, or any training program leading to employment, to fail to take all reasonable steps necessary to prevent discrimination and harassment from occurring.
(l)(1)For an employer or other entity covered by this part to refuse to hire or employ a person or to refuse to select a person for a training program leading to employment or to bar or to discharge a person from employment or from a training program leading to employment, or to discriminate against a person in compensation or in terms, conditions, or privileges of employment because of a conflict between the persons religious belief or observance and any employment requirement, unless the employer or other entity covered by this part demonstrates that it has explored any available reasonable alternative means of accommodating the religious belief or observance, including the possibilities of excusing the person from those duties that conflict with the persons religious belief or observance or permitting those duties to be performed at another time or by another person, but is unable to reasonably accommodate the religious belief or observance without undue hardship, as defined in subdivision (u) of Section 12926, on the conduct of the business of the employer or other entity covered by this part. Religious belief or observance, as used in this section, includes, but is not limited to, observance of a Sabbath or other religious holy day or days, reasonable time necessary for travel prior and subsequent to a religious observance, and religious dress practice and religious grooming practice as described in subdivision (q) of Section 12926. This subdivision shall also apply to an apprenticeship training program, an unpaid internship, and any other program to provide unpaid experience for a person in the workplace or industry.
(2)An accommodation of an individuals religious dress practice or religious grooming practice is not reasonable if the accommodation requires segregation of the individual from other employees or the public.
(3)An accommodation is not required under this subdivision if it would result in a violation of this part or any other law prohibiting discrimination or protecting civil rights, including subdivision (b) of Section 51 of the Civil Code and Section 11135 of this code.
(4)For an employer or other entity covered by this part to, in addition to the employee protections provided pursuant to subdivision (h), retaliate or otherwise discriminate against a person for requesting accommodation under this subdivision, regardless of whether the request was granted.
(m)(1)For an employer or other entity covered by this part to fail to make reasonable accommodation for the known physical or mental disability of an applicant or employee. Nothing in this subdivision or in paragraph (1) or (2) of subdivision (a) shall be construed to require an accommodation that is demonstrated by the employer or other covered entity to produce undue hardship, as defined in subdivision (u) of Section 12926, to its operation.
(2)For an employer or other entity covered by this part to, in addition to the employee protections provided pursuant to subdivision (h), retaliate or otherwise discriminate against a person for requesting accommodation under this subdivision, regardless of whether the request was granted.
(n)For an employer or other entity covered by this part to fail to engage in a timely, good faith, interactive process with the employee or applicant to determine effective reasonable accommodations, if any, in response to a request for reasonable accommodation by an employee or applicant with a known physical or mental disability or known medical condition.
(o)For an employer or other entity covered by this part, to subject, directly or indirectly, any employee, applicant, or other person to a test for the presence of a genetic characteristic.
(p)For an employer to require, as a condition of employment, continued employment, or a benefit of employment, the disclosure of information relating to an applicants or employees reproductive health decisionmaking.
(q)Nothing in this section shall be interpreted as preventing the ability of employers to identify members of the military or veterans for purposes of awarding a veterans preference as permitted by law.
SEC. 8.Section 12944 of the Government Code, as amended by Section 38 of Chapter 48 of the Statutes of 2022, is amended to read:12944.(a)It shall be unlawful for a licensing board to require any examination or establish any other qualification for licensing that has an adverse impact on any class by virtue of its race, creed, color, national origin or ancestry, sex, gender, gender identity, gender expression, age, medical condition, genetic information, physical disability, mental disability, reproductive health decisionmaking, or sexual orientation, unless the practice can be demonstrated to be job related.
Where the council, after hearing, determines that an examination is unlawful under this subdivision, the licensing board may continue to use and rely on the examination until such time as judicial review by the superior court of the determination is exhausted.
If an examination or other qualification for licensing is determined to be unlawful under this section, that determination shall not void, limit, repeal, or otherwise affect any right, privilege, status, or responsibility previously conferred upon any person by the examination or by a license issued in reliance on the examination or qualification.
(b)It shall be unlawful for a licensing board to fail or refuse to make reasonable accommodation to an individuals mental or physical disability or medical condition.
(c)It shall be unlawful for any licensing board, unless specifically acting in accordance with federal equal employment opportunity guidelines or regulations approved by the council, to print or circulate or cause to be printed or circulated any publication, or to make any non-job-related inquiry, either verbal or through use of an application form, which expresses, directly or indirectly, any limitation, specification, or discrimination as to race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, sex, gender, gender identity, gender expression, age, reproductive health decisionmaking, or sexual orientation or any intent to make any such limitation, specification, or discrimination. Nothing in this subdivision shall prohibit any licensing board from making, in connection with prospective licensure or certification, an inquiry as to, or a request for information regarding, the physical fitness of applicants if that inquiry or request for information is directly related and pertinent to the license or the licensed position the applicant is applying for. Nothing in this subdivision shall prohibit any licensing board, in connection with prospective examinations, licensure, or certification, from inviting individuals with physical or mental disabilities to request reasonable accommodations or from making inquiries related to reasonable accommodations.
(d)It is unlawful for a licensing board to discriminate against any person because the person has filed a complaint, testified, or assisted in any proceeding under this part.
(e)It is unlawful for any licensing board to fail to keep records of applications for licensing or certification for a period of two years following the date of receipt of the applications.
(f)As used in this section, licensing board means any state board, agency, or authority in the Business, Consumer Services, and Housing Agency that has the authority to grant licenses or certificates which are prerequisites to employment eligibility or professional status.
SEC. 9.Section 12993 of the Government Code is amended to read:12993.(a)The provisions of this part shall be construed liberally for the accomplishment of the purposes of this part. This part does not repeal any of the provisions of civil rights law or of any other law of this state relating to discrimination because of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, reproductive health decisionmaking, or sexual orientation, unless those provisions provide less protection to the enumerated classes of persons covered under this part.
(b)The provisions in this part relating to discrimination in employment on account of sex or medical condition do not affect the operation of the terms or conditions of any bona fide retirement, pension, employee benefit, or insurance plan, provided the terms or conditions are in accordance with customary and reasonable or actuarially sound underwriting practices.
(c)While it is the intention of the Legislature to occupy the field of regulation of discrimination in employment and housing encompassed by the provisions of this part, exclusive of all other laws banning discrimination in employment and housing by any city, city and county, county, or other political subdivision of the state, this part does not limit or restrict the application of Section 51 of the Civil Code.
SEC. 10.Section 22853.3 is added to the Government Code, to read:22853.3.Commencing January 1, 2024, a health benefit plan or contract shall provide coverage for contraceptives and related services consistent with the requirements under Section 1367.25 of the Health and Safety Code and Section 10123.196 of the Insurance Code.
SEC. 11.Section 22853.4 is added to the Government Code, to read:22853.4.Commencing January 1, 2024, a health benefit plan or contract shall provide coverage for vasectomies and related services consistent with the requirements under Section 1367.255 of the Health and Safety Code and Section 10123.1945 of the Insurance Code.
SEC. 12.Section 1343 of the Health and Safety Code is amended to read:1343.(a)This chapter shall apply to health care service plans and specialized health care service plan contracts as defined in subdivisions (f) and (o) of Section 1345.
(b)The director may by the adoption of rules or the issuance of orders deemed necessary and appropriate, either unconditionally or upon specified terms and conditions or for specified periods, exempt from this chapter any class of persons or plan contracts if the director finds the action to be in the public interest and not detrimental to the protection of subscribers, enrollees, or persons regulated under this chapter, and that the regulation of the persons or plan contracts is not essential to the purposes of this chapter.
(c)The director, upon request of the Director of Health Care Services, shall exempt from this chapter any county-operated pilot program contracting with the State Department of Health Care Services pursuant to Article 7 (commencing with Section 14490) of Chapter 8 of Part 3 of Division 9 of the Welfare and Institutions Code. The director may exempt noncounty-operated pilot programs upon request of the Director of Health Care Services. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.
(d)Upon the request of the Director of Health Care Services, the director may exempt from this chapter any mental health plan contractor or any capitated rate contract under Chapter 8.9 (commencing with Section 14700) of Part 3 of Division 9 of the Welfare and Institutions Code. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.
(e)This chapter shall not apply to:
(1)A person organized and operating pursuant to a certificate issued by the Insurance Commissioner unless the entity is directly providing the health care service through those entity-owned or contracting health facilities and providers, in which case this chapter shall apply to the insurers plan and to the insurer.
(2)A plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, except that a plan described in this paragraph shall be subject to Section 1367.33.
(3)A person who does all of the following:
(A)Promises to provide care for life or for more than one year in return for a transfer of consideration from, or on behalf of, a person 60 years of age or older.
(B)Has obtained a written license pursuant to Chapter 2 (commencing with Section 1250) or Chapter 3.2 (commencing with Section 1569).
(C)Has obtained a certificate of authority from the State Department of Social Services.
(4)The Major Risk Medical Insurance Board when engaging in activities under Chapter 8 (commencing with Section 10700) of Part 2 of Division 2 of the Insurance Code, Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code, and Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code.
(5)The California Small Group Reinsurance Fund.
SEC. 13.Section 1367.25 of the Health and Safety Code is amended to read:1367.25.(a)A group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, and an individual health care service plan contract that is amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, except for a specialized health care service plan contract, shall provide coverage for the following, under general terms and conditions applicable to all benefits:
(1)A health care service plan contract that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods designated by the plan. In the event the patients participating provider, acting within the providers scope of practice, determines that none of the methods designated by the plan is medically appropriate for the patients medical or personal history, the plan shall also provide coverage for another FDA-approved, medically appropriate prescription contraceptive method prescribed by the patients provider.
(2)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(b)(1)A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for all subscribers and enrollees:
(A)(i)Except as provided in clause (ii) and in subparagraphs (B) and (C) of paragraph (2), all FDA-approved contraceptive drugs, devices, and other products, including all FDA-approved contraceptive drugs, devices, and products available over the counter, as prescribed by the enrollees provider.
(ii)For any health care service plan contract described in paragraph (1) that is issued, amended, renewed, or delivered on or after January 1, 2024, both of the following conditions shall apply:
(I)A prescription shall not be required to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(II)Point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products shall be provided at in-network pharmacies without cost sharing or medical management restrictions.
(B)Voluntary tubal ligation and other similar sterilization procedures.
(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device removal.
(2)(A)Except for a grandfathered health plan, a health care service plan subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision. Cost sharing shall not be imposed on any Medi-Cal beneficiary.
(B)If the FDA has approved one or more therapeutic equivalents, as that term is defined by the FDA, of a contraceptive drug, device, or product, a health care service plan is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutic equivalent generic substitute available in the market, a health care service plan shall provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the enrollees provider, a health care service plan shall defer to the determination and judgment of the provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives, and ability to adhere to the appropriate use of the drug or item, as determined by the provider. The department may promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an enrollee, an enrollees designee, or an enrollees provider to request coverage of an alternative prescribed contraceptive. A request for coverage under this subparagraph that is submitted by an enrollee, an enrollees designee, or provider shall be approved by the health care service plan in compliance with the time limits in Section 1367.241 and, as applicable, with the plans Medi-Cal managed care contract.
(3)Except as otherwise authorized under this section, a health care service plan shall not infringe upon an enrollees choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(5)For purposes of this subdivision, health care service plan shall include Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the benefits described in this subdivision are made the financial responsibility of the Medi-Cal managed care plan under its comprehensive risk contract with the State Department of Health Care Services. If some or all of the benefits described in this subdivision are not the financial responsibility of the Medi-Cal managed care plan, as determined by the State Department of Health Care Services, those benefits shall be available to Medi-Cal beneficiaries on a fee-for-service basis pursuant to subdivision (n) of Section 14132 of the Welfare and Institutions Code.
(c)(1)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for FDA-approved contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(d)(1)Every health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an enrollee by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)This subdivision shall not be construed to require a health care service plan contract to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the plans policies governing out-of-network coverage.
(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health care service plan subject to this subdivision, shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply, and shall not require an enrollee to make any formal request for such coverage other than a pharmacy claim.
(e)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee.
(f)This section shall not be construed to deny or restrict in any way the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(g)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(h)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to health care service plan contracts issued, amended, or renewed on or after January 1, 2016, provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of this code.
(4)For purposes of this section, over-the-counter FDA-approved contraceptive drugs, devices, and products and over-the-counter birth control methods are limited to those included as essential health benefits pursuant to Section 1367.005.
SEC. 14.Section 1367.255 is added to the Health and Safety Code, immediately following Section 1367.25, to read:1367.255.(a)(1)A health care service plan contract issued, amended, renewed, or delivered on or after January 1, 2024, except for a grandfathered health plan or a qualifying health plan for a health savings account, shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy services and procedures. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost sharing for vasectomy services and procedures at the minimum level necessary to preserve the enrollees ability to claim tax-exempt contributions and withdrawals from the enrollees health savings account under Internal Revenue Service laws, regulations, and guidance. Cost sharing shall not be imposed on a Medi-Cal beneficiary.
(2)A health care service plan shall not impose any restrictions or delays, including, but not limited to, prior authorization, on vasectomy services or procedures.
(3)Benefits for an enrollee under this section shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(4)For purposes of this section, health care service plan includes Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the benefits described in this subdivision are made the financial responsibility of the Medi-Cal managed care plan under its comprehensive risk contract with the State Department of Health Care Services. If some or all of the benefits described in this subdivision are not the financial responsibility of the Medi-Cal managed care plan, as determined by the State Department of Health Care Services, those benefits shall be available to Medi-Cal beneficiaries on a fee-for-service basis pursuant to subdivision (n) of Section 14132 of the Welfare and Institutions Code.
(5)Utilization controls applicable to services described in this section provided by a Medi-Cal managed care plan shall be subject to this section.
(b)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for vasectomy services and procedures. The exclusion from coverage under this provision shall not apply to vasectomy services or procedures for purposes other than contraception.
(1)A health care service plan that contracts with a religious employer to provide a health care service plan that does not include coverage and benefits for vasectomy services and procedures shall notify, in writing, upon initial enrollment and annually thereafter upon renewal, each enrollee that vasectomy services and procedures are not included in the enrollees health care service plan.
(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(c)This section shall not be construed to deny or restrict in any way the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(d)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(e)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
SEC. 15.Section 1367.33 is added to the Health and Safety Code, to read:1367.33.Notwithstanding any other law, a plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, and that is issued, amended, renewed, or delivered, on or after January 1, 2024, shall comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255.
SEC. 16.Section 10123.1945 is added to the Insurance Code, immediately following Section 10123.194, to read:10123.1945.(a)(1)A disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, except for a grandfathered health plan or a qualifying health plan for a health savings account, shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy services or procedures. For a qualifying health plan for a health savings account, an insurer shall establish the plans cost sharing for vasectomy services and procedures at the minimum level necessary to preserve the insureds ability to claim tax-exempt contributions and withdrawals from the insureds health savings account under Internal Revenue Service laws, regulations, and guidance.
(2)An insurer shall not impose any restrictions or delays, including, but not limited to, prior authorization, on vasectomy services and procedures.
(3)Coverage with respect to an insured under this section shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)This section shall not be construed to deny or restrict in any way an existing right or benefit provided under law or by contract.
(c)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(d)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for vasectomy services and procedures. The exclusion from coverage under this provision shall not apply to vasectomy services or procedures for purposes other than contraception.
(1)An insurer that contracts with a religious employer to provide a disability insurance policy that does not include coverage and benefits for vasectomy services and procedures shall notify, in writing, upon initial enrollment and annually thereafter upon renewal, each enrollee that vasectomy services and procedures are not included in the insureds disability insurance policy.
(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(e)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(f)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
SEC. 17.Section 10123.196 of the Insurance Code is amended to read:10123.196.(a)An individual or group policy of disability insurance issued, amended, renewed, or delivered on or after January 1, 2000, through December 31, 2015, inclusive, that provides coverage for hospital, medical, or surgical expenses, shall provide coverage for the following, under the same terms and conditions as applicable to all benefits:
(1)A disability insurance policy that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods, as designated by the insurer. If an insureds health care provider determines that none of the methods designated by the disability insurer is medically appropriate for the insureds medical or personal history, the insurer shall, in the alternative, provide coverage for some other FDA-approved prescription contraceptive method prescribed by the patients health care provider.
(2)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for all policyholders and insureds:
(A)(i)Except as provided in clause (ii) and in subparagraphs (B) and (C) of paragraph (2), all FDA-approved, contraceptive drugs, devices, and other products, including all FDA-approved, contraceptive drugs, devices, and products available over the counter, as prescribed by the insureds provider.
(ii)For any policy described in paragraph (1) that is issued, amended, renewed, or delivered on or after January 1, 2024, both of the following conditions shall apply:
(I)A prescription shall not be required to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(II)Point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products shall be provided at in-network pharmacies without cost sharing or medical management restrictions.
(B)Voluntary tubal ligation and other similar sterilization procedures.
(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device removal.
(2)(A)Except for a grandfathered health plan, a disability insurer subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision.
(B)If the FDA has approved one or more therapeutic equivalents, as that term is defined by the FDA, of a contraceptive drug, device, or product, a disability insurer is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, an insurer shall provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the insureds provider, a disability insurer shall defer to the determination and judgment of the provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives, and ability to adhere to the appropriate use of the drug or item, as determined by the provider. The department may promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an insured, an insureds designee, or an insureds provider to request coverage of an alternative prescribed contraceptive. A request for coverage under this subparagraph that is submitted by an insured, an insureds designee, or a provider shall be approved by the disability insurer in compliance with the time limits in Section 10123.191.
(3)Except as otherwise authorized under this section, an insurer shall not infringe upon an insureds choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(c)This section shall not be construed to deny or restrict in any way any existing right or benefit provided under law or by contract.
(d)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(e)(1)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(f)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an insured by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)This subdivision shall not be construed to require a policy to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the insurers policies governing out-of-network coverage.
(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)An insurer subject to this subdivision shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply, and shall not require an insured to make any formal request for such coverage other than a pharmacy claim.
(g)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an insured.
(h)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(i)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to policies of disability insurance issued, amended, or renewed on or after January 1, 2016, health care provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
(4)For purposes of this section, over-the-counter FDA-approved contraceptive drugs, devices, and products and over-the-counter birth control methods are limited to those included as essential health benefits pursuant to Section 10112.27.
SEC. 18.Section 10127.09 is added to the Insurance Code, to read:10127.09.Notwithstanding any other law, a disability insurance policy that provides hospital, medical, surgical, prescription drug, or nursing benefits, except a policy providing only dental or vision benefits, that is issued, amended, renewed, or delivered, on or after January 1, 2024, and that is issued to a bona fide public or private institution of higher learning and provides coverage to its students and their dependents, or to its faculty, staff, administration, and their respective dependents, shall comply with the coverage requirements of Sections 10123.1945 and 10123.196.
SEC. 19.Section 10509.5 is added to the Public Contract Code, to read:10509.5.Notwithstanding any other law, commencing January 1, 2024, the University of California shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255 of the Health and Safety Code Sections 10123.1945 and 10123.196 of the Insurance Code.
SEC. 20.Section 10828 is added to the Public Contract Code, to read:10828.Notwithstanding any other law, commencing January 1, 2024, the California State University shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255 of the Health and Safety Code, and Sections 10123.1945 and 10123.196 of the Insurance Code.
SEC. 21.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
SEC. 22.Section 5.5 of this bill incorporates amendments to Section 12926 of the Government Code proposed by both this bill and Assembly Bill 1766. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2023, (2) each bill amends Section 12926 of the Government Code, and (3) this bill is enacted after Assembly Bill 1766, in which case Section 5 of this bill shall not become operative.
SEC. 23.Section 6.5 of this bill incorporates amendments to Section 12931 of the Government Code proposed by both this bill and Assembly Bill 2960. That section shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2023, (2) each bill amends Section 12931 of the Government Code, and (3) this bill is enacted after Assembly Bill 2960, in which case Section 6 of this bill shall not become operative.
This act shall be known, and may be cited, as the Contraceptive Equity Act of 2022.
SEC. 2.The Legislature finds and declares all of the following:
(a)California has a long history of expanding timely access to birth control to prevent unintended pregnancy. Thanks to a combination of innovative policies and programs enacted statewide, unintended pregnancy rates are at a 30-year low.
(b)Despite the progress made, health disparities in reproductive health outcomes persist among Black, Indigenous and People of Color, including disproportionate unintended pregnancy, infant and maternal mortality, and sexually transmitted infection rates. The Legislature must take action to ensure that all Californians have equitable access to preventive contraceptive care.
(c)The federal Patient Protection and Affordable Care Act (Public Law 111-148) included a mandate that most health insurance plans cover contraception without out-of-pocket costs for patients.
(d)Californias Contraceptive Coverage Equity Act of 2014 and the Annual Supply of Contraceptives Act of 2016, built on this federal policy and existing state law to be the first state in the country to require coverage of birth control methods approved by the federal Food and Drug Administration for women without cost sharing or restrictions and a 12-month supply of self-administered birth control dispensed at one time for individuals enrolled in health insurance plans and policies regulated by the Knox-Keene Health Care Service Plan Act of 1975.
(e)Since 2014, several other states have expanded on Californias model legislation to create more equitable contraceptive coverage and access by requiring most health insurance plans and policies to cover voluntary sterilization services and all birth control methods available over-the-counter without a prescription for all beneficiaries, regardless of gender.
(f)A report by the Guttmacher Institute shows that vasectomy is among the most effective and cost-effective contraceptive methods available.
(g)Trump-era attacks on birth control access have underscored the need to codify the expansion of contraceptive coverage for as many Californians as possible under state law.
(h)The COVID-19 public health emergency has also further illuminated the structural inequities that disproportionately affect youth, low-income people and communities of color in accessing birth control services. A report by the Guttmacher Institute revealed that 29 percent of White women, 38 percent of Black women and 45 percent of Latinas now face difficulties accessing birth control as a result of the pandemic.
(i)The Legislature intends to reduce sexual and reproductive health disparities and ensure greater health equity by providing a pathway for more Californians to get the contraceptive care they want, when they need it without inequitable delays or cost barriers.
(j)The Legislature intends for the relevant California departments and agencies to work in concert to ensure compliance with these provisions.
SEC. 3.Section 12920 of the Government Code is amended to read:12920.It is hereby declared as the public policy of this state that it is necessary to protect and safeguard the right and opportunity of all persons to seek, obtain, and hold employment without discrimination or abridgment on account of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or military and veteran status.
It is recognized that the practice of denying employment opportunity and discriminating in the terms of employment for these reasons foments domestic strife and unrest, deprives the state of the fullest utilization of its capacities for development and advancement, and substantially and adversely affects the interests of employees, employers, and the public in general.
Further, the practice of discrimination because of race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, familial status, source of income, disability, veteran or military status, or genetic information in housing accommodations is declared to be against public policy.
It is the purpose of this part to provide effective remedies that will eliminate these discriminatory practices.
This part shall be deemed an exercise of the police power of the state for the protection of the welfare, health, and peace of the people of this state.
SEC. 4.Section 12921 of the Government Code is amended to read:12921.(a)The opportunity to seek, obtain, and hold employment without discrimination because of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status is hereby recognized as and declared to be a civil right.
(b)The opportunity to seek, obtain, and hold housing without discrimination because of race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, familial status, source of income, disability, veteran or military status, genetic information, or any other basis prohibited by Section 51 of the Civil Code is hereby recognized as and declared to be a civil right.
SEC. 5.Section 12926 of the Government Code is amended to read:12926.As used in this part in connection with unlawful practices, unless a different meaning clearly appears from the context:
(a)Affirmative relief or prospective relief includes the authority to order reinstatement of an employee, awards of backpay, reimbursement of out-of-pocket expenses, hiring, transfers, reassignments, grants of tenure, promotions, cease and desist orders, posting of notices, training of personnel, testing, expunging of records, reporting of records, and any other similar relief that is intended to correct unlawful practices under this part.
(b)Age refers to the chronological age of any individual who has reached a 40th birthday.
(c)Except as provided by Section 12926.05, employee does not include any individual employed by that persons parent, spouse, or child or any individual employed under a special license in a nonprofit sheltered workshop or rehabilitation facility.
(d)Employer includes any person regularly employing five or more persons, or any person acting as an agent of an employer, directly or indirectly, the state or any political or civil subdivision of the state, and cities, except as follows:
Employer does not include a religious association or corporation not organized for private profit.
(e)Employment agency includes any person undertaking for compensation to procure employees or opportunities to work.
(f)Essential functions means the fundamental job duties of the employment position the individual with a disability holds or desires. Essential functions does not include the marginal functions of the position.
(1)A job function may be considered essential for any of several reasons, including, but not limited to, any one or more of the following:
(A)The function may be essential because the reason the position exists is to perform that function.
(B)The function may be essential because of the limited number of employees available among whom the performance of that job function can be distributed.
(C)The function may be highly specialized, so that the incumbent in the position is hired based on expertise or the ability to perform a particular function.
(2)Evidence of whether a particular function is essential includes, but is not limited to, the following:
(A)The employers judgment as to which functions are essential.
(B)Written job descriptions prepared before advertising or interviewing applicants for the job.
(C)The amount of time spent on the job performing the function.
(D)The consequences of not requiring the incumbent to perform the function.
(E)The terms of a collective bargaining agreement.
(F)The work experiences of past incumbents in the job.
(G)The current work experience of incumbents in similar jobs.
(g)(1)Genetic information means, with respect to any individual, information about any of the following:
(A)The individuals genetic tests.
(B)The genetic tests of family members of the individual.
(C)The manifestation of a disease or disorder in family members of the individual.
(2)Genetic information includes any request for, or receipt of, genetic services, or participation in clinical research that includes genetic services, by an individual or any family member of the individual.
(3)Genetic information does not include information about the sex or age of any individual.
(h)Labor organization includes any organization that exists and is constituted for the purpose, in whole or in part, of collective bargaining or of dealing with employers concerning grievances, terms or conditions of employment, or of other mutual aid or protection.
(i)Medical condition means either of the following:
(1)Any health impairment related to or associated with a diagnosis of cancer or a record or history of cancer.
(2)Genetic characteristics. For purposes of this section, genetic characteristics means either of the following:
(A)Any scientifically or medically identifiable gene or chromosome, or combination or alteration thereof, that is known to be a cause of a disease or disorder in a person or that persons offspring, or that is determined to be associated with a statistically increased risk of development of a disease or disorder, and that is presently not associated with any symptoms of any disease or disorder.
(B)Inherited characteristics that may derive from the individual or family member, that are known to be a cause of a disease or disorder in a person or that persons offspring, or that are determined to be associated with a statistically increased risk of development of a disease or disorder, and that are presently not associated with any symptoms of any disease or disorder.
(j)Mental disability includes, but is not limited to, all of the following:
(1)Having any mental or psychological disorder or condition, such as intellectual disability, organic brain syndrome, emotional or mental illness, or specific learning disabilities, that limits a major life activity. For purposes of this section:
(A)Limits shall be determined without regard to mitigating measures, such as medications, assistive devices, or reasonable accommodations, unless the mitigating measure itself limits a major life activity.
(B)A mental or psychological disorder or condition limits a major life activity if it makes the achievement of the major life activity difficult.
(C)Major life activities shall be broadly construed and shall include physical, mental, and social activities and working.
(2)Any other mental or psychological disorder or condition not described in paragraph (1) that requires special education or related services.
(3)Having a record or history of a mental or psychological disorder or condition described in paragraph (1) or (2), which is known to the employer or other entity covered by this part.
(4)Being regarded or treated by the employer or other entity covered by this part as having, or having had, any mental condition that makes achievement of a major life activity difficult.
(5)Being regarded or treated by the employer or other entity covered by this part as having, or having had, a mental or psychological disorder or condition that has no present disabling effect, but that may become a mental disability as described in paragraph (1) or (2).
Mental disability does not include sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from the current unlawful use of controlled substances or other drugs.
(k)Veteran or military status means a member or veteran of the United States Armed Forces, United States Armed Forces Reserve, the United States National Guard, and the California National Guard.
(l)On the bases enumerated in this part means or refers to discrimination on the basis of one or more of the following: race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, sexual orientation, reproductive health decisionmaking, or veteran or military status.
(m)Physical disability includes, but is not limited to, all of the following:
(1)Having any physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss that does both of the following:
(A)Affects one or more of the following body systems: neurological, immunological, musculoskeletal, special sense organs, respiratory, including speech organs, cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine.
(B)Limits a major life activity. For purposes of this section:
(i)Limits shall be determined without regard to mitigating measures such as medications, assistive devices, prosthetics, or reasonable accommodations, unless the mitigating measure itself limits a major life activity.
(ii)A physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss limits a major life activity if it makes the achievement of the major life activity difficult.
(iii)Major life activities shall be broadly construed and includes physical, mental, and social activities and working.
(2)Any other health impairment not described in paragraph (1) that requires special education or related services.
(3)Having a record or history of a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment described in paragraph (1) or (2), which is known to the employer or other entity covered by this part.
(4)Being regarded or treated by the employer or other entity covered by this part as having, or having had, any physical condition that makes achievement of a major life activity difficult.
(5)Being regarded or treated by the employer or other entity covered by this part as having, or having had, a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment that has no present disabling effect but may become a physical disability as described in paragraph (1) or (2).
(6)Physical disability does not include sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from the current unlawful use of controlled substances or other drugs.
(n)Notwithstanding subdivisions (j) and (m), if the definition of disability used in the federal Americans with Disabilities Act of 1990 (Public Law 101-336) would result in broader protection of the civil rights of individuals with a mental disability or physical disability, as defined in subdivision (j) or (m), or would include any medical condition not included within those definitions, then that broader protection or coverage shall be deemed incorporated by reference into, and shall prevail over conflicting provisions of, the definitions in subdivisions (j) and (m).
(o)Race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, sexual orientation, reproductive health decisionmaking, or veteran or military status includes a perception that the person has any of those characteristics or that the person is associated with a person who has, or is perceived to have, any of those characteristics.
(p)Reasonable accommodation may include either of the following:
(1)Making existing facilities used by employees readily accessible to, and usable by, individuals with disabilities.
(2)Job restructuring, part-time or modified work schedules, reassignment to a vacant position, acquisition or modification of equipment or devices, adjustment or modifications of examinations, training materials or policies, the provision of qualified readers or interpreters, and other similar accommodations for individuals with disabilities.
(q)Religious creed, religion, religious observance, religious belief, and creed include all aspects of religious belief, observance, and practice, including religious dress and grooming practices. Religious dress practice shall be construed broadly to include the wearing or carrying of religious clothing, head or face coverings, jewelry, artifacts, and any other item that is part of an individual observing a religious creed. Religious grooming practice shall be construed broadly to include all forms of head, facial, and body hair that are part of an individual observing a religious creed.
(r)(1)Sex includes, but is not limited to, the following:
(A)Pregnancy or medical conditions related to pregnancy.
(B)Childbirth or medical conditions related to childbirth.
(C)Breastfeeding or medical conditions related to breastfeeding.
(2)Sex also includes, but is not limited to, a persons gender. Gender means sex, and includes a persons gender identity and gender expression. Gender expression means a persons gender-related appearance and behavior whether or not stereotypically associated with the persons assigned sex at birth.
(s)Sexual orientation means heterosexuality, homosexuality, and bisexuality.
(t)Supervisor means any individual having the authority, in the interest of the employer, to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline other employees, or the responsibility to direct them, or to adjust their grievances, or effectively to recommend that action, if, in connection with the foregoing, the exercise of that authority is not of a merely routine or clerical nature, but requires the use of independent judgment.
(u)Undue hardship means an action requiring significant difficulty or expense, when considered in light of the following factors:
(1)The nature and cost of the accommodation needed.
(2)The overall financial resources of the facilities involved in the provision of the reasonable accommodations, the number of persons employed at the facility, and the effect on expenses and resources or the impact otherwise of these accommodations upon the operation of the facility.
(3)The overall financial resources of the covered entity, the overall size of the business of a covered entity with respect to the number of employees, and the number, type, and location of its facilities.
(4)The type of operations, including the composition, structure, and functions of the workforce of the entity.
(5)The geographic separateness or administrative or fiscal relationship of the facility or facilities.
(v)National origin discrimination includes, but is not limited to, discrimination on the basis of possessing a drivers license granted under Section 12801.9 of the Vehicle Code.
(w)Race is inclusive of traits historically associated with race, including, but not limited to, hair texture and protective hairstyles.
(x)Protective hairstyles includes, but is not limited to, such hairstyles as braids, locks, and twists.
(y)Reproductive health decisionmaking includes, but is not limited to, a decision to use or access a particular drug, device, product, or medical service for reproductive health. This subdivision and other provisions in this part relating to reproductive health care decisionmaking shall not be construed to mean that subdivision (r) of this section and other provisions in this part related to sex do not include reproductive health decisionmaking.
SEC. 5.5.Section 12926 of the Government Code is amended to read:12926.As used in this part in connection with unlawful practices, unless a different meaning clearly appears from the context:
(a)Affirmative relief or prospective relief includes the authority to order reinstatement of an employee, awards of backpay, reimbursement of out-of-pocket expenses, hiring, transfers, reassignments, grants of tenure, promotions, cease and desist orders, posting of notices, training of personnel, testing, expunging of records, reporting of records, and any other similar relief that is intended to correct unlawful practices under this part.
(b)Age refers to the chronological age of any individual who has reached a 40th birthday.
(c)Except as provided by Section 12926.05, employee does not include any individual employed by that persons parent, spouse, or child or any individual employed under a special license in a nonprofit sheltered workshop or rehabilitation facility.
(d)Employer includes any person regularly employing five or more persons, or any person acting as an agent of an employer, directly or indirectly, the state or any political or civil subdivision of the state, and cities, except as follows:
Employer does not include a religious association or corporation not organized for private profit.
(e)Employment agency includes any person undertaking for compensation to procure employees or opportunities to work.
(f)Essential functions means the fundamental job duties of the employment position the individual with a disability holds or desires. Essential functions does not include the marginal functions of the position.
(1)A job function may be considered essential for any of several reasons, including, but not limited to, any one or more of the following:
(A)The function may be essential because the reason the position exists is to perform that function.
(B)The function may be essential because of the limited number of employees available among whom the performance of that job function can be distributed.
(C)The function may be highly specialized, so that the incumbent in the position is hired based on expertise or the ability to perform a particular function.
(2)Evidence of whether a particular function is essential includes, but is not limited to, the following:
(A)The employers judgment as to which functions are essential.
(B)Written job descriptions prepared before advertising or interviewing applicants for the job.
(C)The amount of time spent on the job performing the function.
(D)The consequences of not requiring the incumbent to perform the function.
(E)The terms of a collective bargaining agreement.
(F)The work experiences of past incumbents in the job.
(G)The current work experience of incumbents in similar jobs.
(g)(1)Genetic information means, with respect to any individual, information about any of the following:
(A)The individuals genetic tests.
(B)The genetic tests of family members of the individual.
(C)The manifestation of a disease or disorder in family members of the individual.
(2)Genetic information includes any request for, or receipt of, genetic services, or participation in clinical research that includes genetic services, by an individual or any family member of the individual.
(3)Genetic information does not include information about the sex or age of any individual.
(h)Labor organization includes any organization that exists and is constituted for the purpose, in whole or in part, of collective bargaining or of dealing with employers concerning grievances, terms or conditions of employment, or of other mutual aid or protection.
(i)Medical condition means either of the following:
(1)Any health impairment related to or associated with a diagnosis of cancer or a record or history of cancer.
(2)Genetic characteristics. For purposes of this section, genetic characteristics means either of the following:
(A)Any scientifically or medically identifiable gene or chromosome, or combination or alteration thereof, that is known to be a cause of a disease or disorder in a person or that persons offspring, or that is determined to be associated with a statistically increased risk of development of a disease or disorder, and that is presently not associated with any symptoms of any disease or disorder.
(B)Inherited characteristics that may derive from the individual or family member, that are known to be a cause of a disease or disorder in a person or that persons offspring, or that are determined to be associated with a statistically increased risk of development of a disease or disorder, and that are presently not associated with any symptoms of any disease or disorder.
(j)Mental disability includes, but is not limited to, all of the following:
(1)Having any mental or psychological disorder or condition, such as intellectual disability, organic brain syndrome, emotional or mental illness, or specific learning disabilities, that limits a major life activity. For purposes of this section:
(A)Limits shall be determined without regard to mitigating measures, such as medications, assistive devices, or reasonable accommodations, unless the mitigating measure itself limits a major life activity.
(B)A mental or psychological disorder or condition limits a major life activity if it makes the achievement of the major life activity difficult.
(C)Major life activities shall be broadly construed and shall include physical, mental, and social activities and working.
(2)Any other mental or psychological disorder or condition not described in paragraph (1) that requires special education or related services.
(3)Having a record or history of a mental or psychological disorder or condition described in paragraph (1) or (2), which is known to the employer or other entity covered by this part.
(4)Being regarded or treated by the employer or other entity covered by this part as having, or having had, any mental condition that makes achievement of a major life activity difficult.
(5)Being regarded or treated by the employer or other entity covered by this part as having, or having had, a mental or psychological disorder or condition that has no present disabling effect, but that may become a mental disability as described in paragraph (1) or (2).
Mental disability does not include sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from the current unlawful use of controlled substances or other drugs.
(k)Veteran or military status means a member or veteran of the United States Armed Forces, United States Armed Forces Reserve, the United States National Guard, and the California National Guard.
(l)On the bases enumerated in this part means or refers to discrimination on the basis of one or more of the following: race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, sexual orientation, reproductive health decisionmaking, or veteran or military status.
(m)Physical disability includes, but is not limited to, all of the following:
(1)Having any physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss that does both of the following:
(A)Affects one or more of the following body systems: neurological, immunological, musculoskeletal, special sense organs, respiratory, including speech organs, cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine.
(B)Limits a major life activity. For purposes of this section:
(i)Limits shall be determined without regard to mitigating measures such as medications, assistive devices, prosthetics, or reasonable accommodations, unless the mitigating measure itself limits a major life activity.
(ii)A physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss limits a major life activity if it makes the achievement of the major life activity difficult.
(iii)Major life activities shall be broadly construed and includes physical, mental, and social activities and working.
(2)Any other health impairment not described in paragraph (1) that requires special education or related services.
(3)Having a record or history of a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment described in paragraph (1) or (2), which is known to the employer or other entity covered by this part.
(4)Being regarded or treated by the employer or other entity covered by this part as having, or having had, any physical condition that makes achievement of a major life activity difficult.
(5)Being regarded or treated by the employer or other entity covered by this part as having, or having had, a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment that has no present disabling effect but may become a physical disability as described in paragraph (1) or (2).
(6)Physical disability does not include sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from the current unlawful use of controlled substances or other drugs.
(n)Notwithstanding subdivisions (j) and (m), if the definition of disability used in the federal Americans with Disabilities Act of 1990 (Public Law 101-336) would result in broader protection of the civil rights of individuals with a mental disability or physical disability, as defined in subdivision (j) or (m), or would include any medical condition not included within those definitions, then that broader protection or coverage shall be deemed incorporated by reference into, and shall prevail over conflicting provisions of, the definitions in subdivisions (j) and (m).
(o)Race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, sexual orientation, reproductive health decisionmaking, or veteran or military status includes a perception that the person has any of those characteristics or that the person is associated with a person who has, or is perceived to have, any of those characteristics.
(p)Reasonable accommodation may include either of the following:
(1)Making existing facilities used by employees readily accessible to, and usable by, individuals with disabilities.
(2)Job restructuring, part-time or modified work schedules, reassignment to a vacant position, acquisition or modification of equipment or devices, adjustment or modifications of examinations, training materials or policies, the provision of qualified readers or interpreters, and other similar accommodations for individuals with disabilities.
(q)Religious creed, religion, religious observance, religious belief, and creed include all aspects of religious belief, observance, and practice, including religious dress and grooming practices. Religious dress practice shall be construed broadly to include the wearing or carrying of religious clothing, head or face coverings, jewelry, artifacts, and any other item that is part of an individual observing a religious creed. Religious grooming practice shall be construed broadly to include all forms of head, facial, and body hair that are part of an individual observing a religious creed.
(r)(1)Sex includes, but is not limited to, the following:
(A)Pregnancy or medical conditions related to pregnancy.
(B)Childbirth or medical conditions related to childbirth.
(C)Breastfeeding or medical conditions related to breastfeeding.
(2)Sex also includes, but is not limited to, a persons gender. Gender means sex, and includes a persons gender identity and gender expression. Gender expression means a persons gender-related appearance and behavior whether or not stereotypically associated with the persons assigned sex at birth.
(s)Sexual orientation means heterosexuality, homosexuality, and bisexuality.
(t)Supervisor means any individual having the authority, in the interest of the employer, to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline other employees, or the responsibility to direct them, or to adjust their grievances, or effectively to recommend that action, if, in connection with the foregoing, the exercise of that authority is not of a merely routine or clerical nature, but requires the use of independent judgment.
(u)Undue hardship means an action requiring significant difficulty or expense, when considered in light of the following factors:
(1)The nature and cost of the accommodation needed.
(2)The overall financial resources of the facilities involved in the provision of the reasonable accommodations, the number of persons employed at the facility, and the effect on expenses and resources or the impact otherwise of these accommodations upon the operation of the facility.
(3)The overall financial resources of the covered entity, the overall size of the business of a covered entity with respect to the number of employees, and the number, type, and location of its facilities.
(4)The type of operations, including the composition, structure, and functions of the workforce of the entity.
(5)The geographic separateness or administrative or fiscal relationship of the facility or facilities.
(v)National origin discrimination includes, but is not limited to, discrimination on the basis of possessing a drivers license or identification card granted under Section 12801.9 of the Vehicle Code.
(w)Race is inclusive of traits historically associated with race, including, but not limited to, hair texture and protective hairstyles.
(x)Protective hairstyles includes, but is not limited to, such hairstyles as braids, locks, and twists.
(y)Reproductive health decisionmaking includes, but is not limited to, a decision to use or access a particular drug, device, product, or medical service for reproductive health. This subdivision and other provisions in this part relating to reproductive health decisionmaking shall not be construed to mean that subdivision (r) of this section and other provisions in this part related to sex do not include reproductive health decisionmaking.
SEC. 6.Section 12931 of the Government Code is amended to read:12931.The department may also provide assistance to communities and persons therein in resolving disputes, disagreements, or difficulties relating to discriminatory practices based on race, religious creed, color, national origin, ancestry, physical disability, mental disability, veteran or military status, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, familial status, age, reproductive health decisionmaking, or sexual orientation that impair the rights of persons in those communities under the Constitution or laws of the United States or of this state. The services of the department may be made available in cases of these disputes, disagreements, or difficulties only when, in its judgment, peaceful relations among the citizens of the community involved are threatened thereby. The departments services are to be made available only upon the request of an appropriate state or local public body, or upon the request of any person directly affected by any such dispute, disagreement, or difficulty.
The assistance of the department pursuant to this section shall be limited to endeavors at investigation, conference, conciliation, and persuasion.
SEC. 6.5.Section 12931 of the Government Code is amended to read:12931.The department may also provide assistance to communities and persons therein in resolving disputes, disagreements, or difficulties relating to discriminatory practices based on race, religious creed, color, national origin, ancestry, physical disability, mental disability, veteran or military status, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, familial status, age, reproductive health decisionmaking, or sexual orientation that impair the rights of persons in those communities under the Constitution or laws of the United States or of this state. The services of the department may be made available in cases of these disputes, disagreements, or difficulties only when, in its judgment, peaceful relations among the citizens persons of the community involved are threatened thereby. The departments services are to be made available only upon the request of an appropriate state or local public body, or upon the request of any person directly affected by any such the dispute, disagreement, or difficulty.
The assistance of the department pursuant to this section shall be limited to endeavors at investigation, conference, conciliation, and persuasion.
SEC. 7.Section 12940 of the Government Code, as amended by Section 36 of Chapter 48 of the Statutes of 2022, is amended to read:12940.It is an unlawful employment practice, unless based upon a bona fide occupational qualification, or, except where based upon applicable security regulations established by the United States or the State of California:
(a)For an employer, because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decisionmaking, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, or veteran or military status of any person, to refuse to hire or employ the person or to refuse to select the person for a training program leading to employment, or to bar or to discharge the person from employment or from a training program leading to employment, or to discriminate against the person in compensation or in terms, conditions, or privileges of employment.
(1)This part does not prohibit an employer from refusing to hire or discharging an employee with a physical or mental disability, or subject an employer to any legal liability resulting from the refusal to employ or the discharge of an employee with a physical or mental disability, if the employee, because of a physical or mental disability, is unable to perform the employees essential duties even with reasonable accommodations, or cannot perform those duties in a manner that would not endanger the employees health or safety or the health or safety of others even with reasonable accommodations.
(2)This part does not prohibit an employer from refusing to hire or discharging an employee who, because of the employees medical condition, is unable to perform the employees essential duties even with reasonable accommodations, or cannot perform those duties in a manner that would not endanger the employees health or safety or the health or safety of others even with reasonable accommodations. Nothing in this part shall subject an employer to any legal liability resulting from the refusal to employ or the discharge of an employee who, because of the employees medical condition, is unable to perform the employees essential duties, or cannot perform those duties in a manner that would not endanger the employees health or safety or the health or safety of others even with reasonable accommodations.
(3)Nothing in this part relating to discrimination on account of marital status shall do either of the following:
(A)Affect the right of an employer to reasonably regulate, for reasons of supervision, safety, security, or morale, the working of spouses in the same department, division, or facility, consistent with the rules and regulations adopted by the council.
(B)Prohibit bona fide health plans from providing additional or greater benefits to employees with dependents than to those employees without or with fewer dependents.
(4)Nothing in this part relating to discrimination on account of sex shall affect the right of an employer to use veteran status as a factor in employee selection or to give special consideration to Vietnam-era veterans.
(5)(A)This part does not prohibit an employer from refusing to employ an individual because of the individuals age if the law compels or provides for that refusal. Promotions within the existing staff, hiring or promotion on the basis of experience and training, rehiring on the basis of seniority and prior service with the employer, or hiring under an established recruiting program from high schools, colleges, universities, or trade schools do not, in and of themselves, constitute unlawful employment practices.
(B)The provisions of this part relating to discrimination on the basis of age do not prohibit an employer from providing health benefits or health care reimbursement plans to retired persons that are altered, reduced, or eliminated when the person becomes eligible for Medicare health benefits. This subparagraph applies to all retiree health benefit plans and contractual provisions or practices concerning retiree health benefits and health care reimbursement plans in effect on or after January 1, 2011.
(b)For a labor organization, because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status of any person, to exclude, expel, or restrict from its membership the person, or to provide only second-class or segregated membership or to discriminate against any person because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status of the person in the election of officers of the labor organization or in the selection of the labor organizations staff or to discriminate in any way against any of its members or against any employer or against any person employed by an employer.
(c)For any person to discriminate against any person in the selection, termination, training, or other terms or treatment of that person in any apprenticeship training program, any other training program leading to employment, an unpaid internship, or another limited duration program to provide unpaid work experience for that person because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status of the person discriminated against.
(d)For any employer or employment agency to print or circulate or cause to be printed or circulated any publication, or to make any nonjob-related inquiry of an employee or applicant, either verbal or through use of an application form, that expresses, directly or indirectly, any limitation, specification, or discrimination as to race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status, or any intent to make any such limitation, specification, or discrimination. This part does not prohibit an employer or employment agency from inquiring into the age of an applicant, or from specifying age limitations, if the law compels or provides for that action.
(e)(1)Except as provided in paragraph (2) or (3), for any employer or employment agency to require any medical or psychological examination of an applicant, to make any medical or psychological inquiry of an applicant, to make any inquiry whether an applicant has a mental disability or physical disability or medical condition, or to make any inquiry regarding the nature or severity of a physical disability, mental disability, or medical condition.
(2)Notwithstanding paragraph (1), an employer or employment agency may inquire into the ability of an applicant to perform job-related functions and may respond to an applicants request for reasonable accommodation.
(3)Notwithstanding paragraph (1), an employer or employment agency may require a medical or psychological examination or make a medical or psychological inquiry of a job applicant after an employment offer has been made but prior to the commencement of employment duties, provided that the examination or inquiry is job related and consistent with business necessity and that all entering employees in the same job classification are subject to the same examination or inquiry.
(f)(1)Except as provided in paragraph (2), for any employer or employment agency to require any medical or psychological examination of an employee, to make any medical or psychological inquiry of an employee, to make any inquiry whether an employee has a mental disability, physical disability, or medical condition, or to make any inquiry regarding the nature or severity of a physical disability, mental disability, or medical condition.
(2)Notwithstanding paragraph (1), an employer or employment agency may require any examinations or inquiries that it can show to be job related and consistent with business necessity. An employer or employment agency may conduct voluntary medical examinations, including voluntary medical histories, which are part of an employee health program available to employees at that worksite.
(g)For any employer, labor organization, or employment agency to harass, discharge, expel, or otherwise discriminate against any person because the person has made a report pursuant to Section 11161.8 of the Penal Code that prohibits retaliation against hospital employees who report suspected patient abuse by health facilities or community care facilities.
(h)For any employer, labor organization, employment agency, or person to discharge, expel, or otherwise discriminate against any person because the person has opposed any practices forbidden under this part or because the person has filed a complaint, testified, or assisted in any proceeding under this part.
(i)For any person to aid, abet, incite, compel, or coerce the doing of any of the acts forbidden under this part, or to attempt to do so.
(j)(1)For an employer, labor organization, employment agency, apprenticeship training program or any training program leading to employment, or any other person, because of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status, to harass an employee, an applicant, an unpaid intern or volunteer, or a person providing services pursuant to a contract. Harassment of an employee, an applicant, an unpaid intern or volunteer, or a person providing services pursuant to a contract by an employee, other than an agent or supervisor, shall be unlawful if the entity, or its agents or supervisors, knows or should have known of this conduct and fails to take immediate and appropriate corrective action. An employer may also be responsible for the acts of nonemployees, with respect to harassment of employees, applicants, unpaid interns or volunteers, or persons providing services pursuant to a contract in the workplace, if the employer, or its agents or supervisors, knows or should have known of the conduct and fails to take immediate and appropriate corrective action. In reviewing cases involving the acts of nonemployees, the extent of the employers control and any other legal responsibility that the employer may have with respect to the conduct of those nonemployees shall be considered. An entity shall take all reasonable steps to prevent harassment from occurring. Loss of tangible job benefits shall not be necessary in order to establish harassment.
(2)The provisions of this subdivision are declaratory of existing law, except for the new duties imposed on employers with regard to harassment.
(3)An employee of an entity subject to this subdivision is personally liable for any harassment prohibited by this section that is perpetrated by the employee, regardless of whether the employer or covered entity knows or should have known of the conduct and fails to take immediate and appropriate corrective action.
(4)(A)For purposes of this subdivision only, employer means any person regularly employing one or more persons or regularly receiving the services of one or more persons providing services pursuant to a contract, or any person acting as an agent of an employer, directly or indirectly, the state, or any political or civil subdivision of the state, and cities. The definition of employer in subdivision (d) of Section 12926 applies to all provisions of this section other than this subdivision.
(B)Notwithstanding subparagraph (A), for purposes of this subdivision, employer does not include a religious association or corporation not organized for private profit, except as provided in Section 12926.2.
(C)For purposes of this subdivision, harassment because of sex includes sexual harassment, gender harassment, and harassment based on pregnancy, childbirth, or related medical conditions. Sexually harassing conduct need not be motivated by sexual desire.
(5)For purposes of this subdivision, a person providing services pursuant to a contract means a person who meets all of the following criteria:
(A)The person has the right to control the performance of the contract for services and discretion as to the manner of performance.
(B)The person is customarily engaged in an independently established business.
(C)The person has control over the time and place the work is performed, supplies the tools and instruments used in the work, and performs work that requires a particular skill not ordinarily used in the course of the employers work.
(k)For an employer, labor organization, employment agency, apprenticeship training program, or any training program leading to employment, to fail to take all reasonable steps necessary to prevent discrimination and harassment from occurring.
(l)(1)For an employer or other entity covered by this part to refuse to hire or employ a person or to refuse to select a person for a training program leading to employment or to bar or to discharge a person from employment or from a training program leading to employment, or to discriminate against a person in compensation or in terms, conditions, or privileges of employment because of a conflict between the persons religious belief or observance and any employment requirement, unless the employer or other entity covered by this part demonstrates that it has explored any available reasonable alternative means of accommodating the religious belief or observance, including the possibilities of excusing the person from those duties that conflict with the persons religious belief or observance or permitting those duties to be performed at another time or by another person, but is unable to reasonably accommodate the religious belief or observance without undue hardship, as defined in subdivision (u) of Section 12926, on the conduct of the business of the employer or other entity covered by this part. Religious belief or observance, as used in this section, includes, but is not limited to, observance of a Sabbath or other religious holy day or days, reasonable time necessary for travel prior and subsequent to a religious observance, and religious dress practice and religious grooming practice as described in subdivision (q) of Section 12926. This subdivision shall also apply to an apprenticeship training program, an unpaid internship, and any other program to provide unpaid experience for a person in the workplace or industry.
(2)An accommodation of an individuals religious dress practice or religious grooming practice is not reasonable if the accommodation requires segregation of the individual from other employees or the public.
(3)An accommodation is not required under this subdivision if it would result in a violation of this part or any other law prohibiting discrimination or protecting civil rights, including subdivision (b) of Section 51 of the Civil Code and Section 11135 of this code.
(4)For an employer or other entity covered by this part to, in addition to the employee protections provided pursuant to subdivision (h), retaliate or otherwise discriminate against a person for requesting accommodation under this subdivision, regardless of whether the request was granted.
(m)(1)For an employer or other entity covered by this part to fail to make reasonable accommodation for the known physical or mental disability of an applicant or employee. Nothing in this subdivision or in paragraph (1) or (2) of subdivision (a) shall be construed to require an accommodation that is demonstrated by the employer or other covered entity to produce undue hardship, as defined in subdivision (u) of Section 12926, to its operation.
(2)For an employer or other entity covered by this part to, in addition to the employee protections provided pursuant to subdivision (h), retaliate or otherwise discriminate against a person for requesting accommodation under this subdivision, regardless of whether the request was granted.
(n)For an employer or other entity covered by this part to fail to engage in a timely, good faith, interactive process with the employee or applicant to determine effective reasonable accommodations, if any, in response to a request for reasonable accommodation by an employee or applicant with a known physical or mental disability or known medical condition.
(o)For an employer or other entity covered by this part, to subject, directly or indirectly, any employee, applicant, or other person to a test for the presence of a genetic characteristic.
(p)For an employer to require, as a condition of employment, continued employment, or a benefit of employment, the disclosure of information relating to an applicants or employees reproductive health decisionmaking.
(q)Nothing in this section shall be interpreted as preventing the ability of employers to identify members of the military or veterans for purposes of awarding a veterans preference as permitted by law.
SEC. 8.Section 12944 of the Government Code, as amended by Section 38 of Chapter 48 of the Statutes of 2022, is amended to read:12944.(a)It shall be unlawful for a licensing board to require any examination or establish any other qualification for licensing that has an adverse impact on any class by virtue of its race, creed, color, national origin or ancestry, sex, gender, gender identity, gender expression, age, medical condition, genetic information, physical disability, mental disability, reproductive health decisionmaking, or sexual orientation, unless the practice can be demonstrated to be job related.
Where the council, after hearing, determines that an examination is unlawful under this subdivision, the licensing board may continue to use and rely on the examination until such time as judicial review by the superior court of the determination is exhausted.
If an examination or other qualification for licensing is determined to be unlawful under this section, that determination shall not void, limit, repeal, or otherwise affect any right, privilege, status, or responsibility previously conferred upon any person by the examination or by a license issued in reliance on the examination or qualification.
(b)It shall be unlawful for a licensing board to fail or refuse to make reasonable accommodation to an individuals mental or physical disability or medical condition.
(c)It shall be unlawful for any licensing board, unless specifically acting in accordance with federal equal employment opportunity guidelines or regulations approved by the council, to print or circulate or cause to be printed or circulated any publication, or to make any non-job-related inquiry, either verbal or through use of an application form, which expresses, directly or indirectly, any limitation, specification, or discrimination as to race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, sex, gender, gender identity, gender expression, age, reproductive health decisionmaking, or sexual orientation or any intent to make any such limitation, specification, or discrimination. Nothing in this subdivision shall prohibit any licensing board from making, in connection with prospective licensure or certification, an inquiry as to, or a request for information regarding, the physical fitness of applicants if that inquiry or request for information is directly related and pertinent to the license or the licensed position the applicant is applying for. Nothing in this subdivision shall prohibit any licensing board, in connection with prospective examinations, licensure, or certification, from inviting individuals with physical or mental disabilities to request reasonable accommodations or from making inquiries related to reasonable accommodations.
(d)It is unlawful for a licensing board to discriminate against any person because the person has filed a complaint, testified, or assisted in any proceeding under this part.
(e)It is unlawful for any licensing board to fail to keep records of applications for licensing or certification for a period of two years following the date of receipt of the applications.
(f)As used in this section, licensing board means any state board, agency, or authority in the Business, Consumer Services, and Housing Agency that has the authority to grant licenses or certificates which are prerequisites to employment eligibility or professional status.
SEC. 9.Section 12993 of the Government Code is amended to read:12993.(a)The provisions of this part shall be construed liberally for the accomplishment of the purposes of this part. This part does not repeal any of the provisions of civil rights law or of any other law of this state relating to discrimination because of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, reproductive health decisionmaking, or sexual orientation, unless those provisions provide less protection to the enumerated classes of persons covered under this part.
(b)The provisions in this part relating to discrimination in employment on account of sex or medical condition do not affect the operation of the terms or conditions of any bona fide retirement, pension, employee benefit, or insurance plan, provided the terms or conditions are in accordance with customary and reasonable or actuarially sound underwriting practices.
(c)While it is the intention of the Legislature to occupy the field of regulation of discrimination in employment and housing encompassed by the provisions of this part, exclusive of all other laws banning discrimination in employment and housing by any city, city and county, county, or other political subdivision of the state, this part does not limit or restrict the application of Section 51 of the Civil Code.
SEC. 10.Section 22853.3 is added to the Government Code, to read:22853.3.Commencing January 1, 2024, a health benefit plan or contract shall provide coverage for contraceptives and related services consistent with the requirements under Section 1367.25 of the Health and Safety Code and Section 10123.196 of the Insurance Code.
SEC. 11.Section 22853.4 is added to the Government Code, to read:22853.4.Commencing January 1, 2024, a health benefit plan or contract shall provide coverage for vasectomies and related services consistent with the requirements under Section 1367.255 of the Health and Safety Code and Section 10123.1945 of the Insurance Code.
SEC. 12.Section 1343 of the Health and Safety Code is amended to read:1343.(a)This chapter shall apply to health care service plans and specialized health care service plan contracts as defined in subdivisions (f) and (o) of Section 1345.
(b)The director may by the adoption of rules or the issuance of orders deemed necessary and appropriate, either unconditionally or upon specified terms and conditions or for specified periods, exempt from this chapter any class of persons or plan contracts if the director finds the action to be in the public interest and not detrimental to the protection of subscribers, enrollees, or persons regulated under this chapter, and that the regulation of the persons or plan contracts is not essential to the purposes of this chapter.
(c)The director, upon request of the Director of Health Care Services, shall exempt from this chapter any county-operated pilot program contracting with the State Department of Health Care Services pursuant to Article 7 (commencing with Section 14490) of Chapter 8 of Part 3 of Division 9 of the Welfare and Institutions Code. The director may exempt noncounty-operated pilot programs upon request of the Director of Health Care Services. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.
(d)Upon the request of the Director of Health Care Services, the director may exempt from this chapter any mental health plan contractor or any capitated rate contract under Chapter 8.9 (commencing with Section 14700) of Part 3 of Division 9 of the Welfare and Institutions Code. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.
(e)This chapter shall not apply to:
(1)A person organized and operating pursuant to a certificate issued by the Insurance Commissioner unless the entity is directly providing the health care service through those entity-owned or contracting health facilities and providers, in which case this chapter shall apply to the insurers plan and to the insurer.
(2)A plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, except that a plan described in this paragraph shall be subject to Section 1367.33.
(3)A person who does all of the following:
(A)Promises to provide care for life or for more than one year in return for a transfer of consideration from, or on behalf of, a person 60 years of age or older.
(B)Has obtained a written license pursuant to Chapter 2 (commencing with Section 1250) or Chapter 3.2 (commencing with Section 1569).
(C)Has obtained a certificate of authority from the State Department of Social Services.
(4)The Major Risk Medical Insurance Board when engaging in activities under Chapter 8 (commencing with Section 10700) of Part 2 of Division 2 of the Insurance Code, Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code, and Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code.
(5)The California Small Group Reinsurance Fund.
SEC. 13.Section 1367.25 of the Health and Safety Code is amended to read:1367.25.(a)A group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, and an individual health care service plan contract that is amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, except for a specialized health care service plan contract, shall provide coverage for the following, under general terms and conditions applicable to all benefits:
(1)A health care service plan contract that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods designated by the plan. In the event the patients participating provider, acting within the providers scope of practice, determines that none of the methods designated by the plan is medically appropriate for the patients medical or personal history, the plan shall also provide coverage for another FDA-approved, medically appropriate prescription contraceptive method prescribed by the patients provider.
(2)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(b)(1)A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for all subscribers and enrollees:
(A)(i)Except as provided in clause (ii) and in subparagraphs (B) and (C) of paragraph (2), all FDA-approved contraceptive drugs, devices, and other products, including all FDA-approved contraceptive drugs, devices, and products available over the counter, as prescribed by the enrollees provider.
(ii)For any health care service plan contract described in paragraph (1) that is issued, amended, renewed, or delivered on or after January 1, 2024, both of the following conditions shall apply:
(I)A prescription shall not be required to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(II)Point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products shall be provided at in-network pharmacies without cost sharing or medical management restrictions.
(B)Voluntary tubal ligation and other similar sterilization procedures.
(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device removal.
(2)(A)Except for a grandfathered health plan, a health care service plan subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision. Cost sharing shall not be imposed on any Medi-Cal beneficiary.
(B)If the FDA has approved one or more therapeutic equivalents, as that term is defined by the FDA, of a contraceptive drug, device, or product, a health care service plan is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutic equivalent generic substitute available in the market, a health care service plan shall provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the enrollees provider, a health care service plan shall defer to the determination and judgment of the provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives, and ability to adhere to the appropriate use of the drug or item, as determined by the provider. The department may promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an enrollee, an enrollees designee, or an enrollees provider to request coverage of an alternative prescribed contraceptive. A request for coverage under this subparagraph that is submitted by an enrollee, an enrollees designee, or provider shall be approved by the health care service plan in compliance with the time limits in Section 1367.241 and, as applicable, with the plans Medi-Cal managed care contract.
(3)Except as otherwise authorized under this section, a health care service plan shall not infringe upon an enrollees choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(5)For purposes of this subdivision, health care service plan shall include Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the benefits described in this subdivision are made the financial responsibility of the Medi-Cal managed care plan under its comprehensive risk contract with the State Department of Health Care Services. If some or all of the benefits described in this subdivision are not the financial responsibility of the Medi-Cal managed care plan, as determined by the State Department of Health Care Services, those benefits shall be available to Medi-Cal beneficiaries on a fee-for-service basis pursuant to subdivision (n) of Section 14132 of the Welfare and Institutions Code.
(c)(1)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for FDA-approved contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(d)(1)Every health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an enrollee by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)This subdivision shall not be construed to require a health care service plan contract to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the plans policies governing out-of-network coverage.
(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health care service plan subject to this subdivision, shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply, and shall not require an enrollee to make any formal request for such coverage other than a pharmacy claim.
(e)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee.
(f)This section shall not be construed to deny or restrict in any way the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(g)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(h)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to health care service plan contracts issued, amended, or renewed on or after January 1, 2016, provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of this code.
(4)For purposes of this section, over-the-counter FDA-approved contraceptive drugs, devices, and products and over-the-counter birth control methods are limited to those included as essential health benefits pursuant to Section 1367.005.
SEC. 14.Section 1367.255 is added to the Health and Safety Code, immediately following Section 1367.25, to read:1367.255.(a)(1)A health care service plan contract issued, amended, renewed, or delivered on or after January 1, 2024, except for a grandfathered health plan or a qualifying health plan for a health savings account, shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy services and procedures. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost sharing for vasectomy services and procedures at the minimum level necessary to preserve the enrollees ability to claim tax-exempt contributions and withdrawals from the enrollees health savings account under Internal Revenue Service laws, regulations, and guidance. Cost sharing shall not be imposed on a Medi-Cal beneficiary.
(2)A health care service plan shall not impose any restrictions or delays, including, but not limited to, prior authorization, on vasectomy services or procedures.
(3)Benefits for an enrollee under this section shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(4)For purposes of this section, health care service plan includes Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the benefits described in this subdivision are made the financial responsibility of the Medi-Cal managed care plan under its comprehensive risk contract with the State Department of Health Care Services. If some or all of the benefits described in this subdivision are not the financial responsibility of the Medi-Cal managed care plan, as determined by the State Department of Health Care Services, those benefits shall be available to Medi-Cal beneficiaries on a fee-for-service basis pursuant to subdivision (n) of Section 14132 of the Welfare and Institutions Code.
(5)Utilization controls applicable to services described in this section provided by a Medi-Cal managed care plan shall be subject to this section.
(b)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for vasectomy services and procedures. The exclusion from coverage under this provision shall not apply to vasectomy services or procedures for purposes other than contraception.
(1)A health care service plan that contracts with a religious employer to provide a health care service plan that does not include coverage and benefits for vasectomy services and procedures shall notify, in writing, upon initial enrollment and annually thereafter upon renewal, each enrollee that vasectomy services and procedures are not included in the enrollees health care service plan.
(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(c)This section shall not be construed to deny or restrict in any way the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(d)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(e)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
SEC. 15.Section 1367.33 is added to the Health and Safety Code, to read:1367.33.Notwithstanding any other law, a plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, and that is issued, amended, renewed, or delivered, on or after January 1, 2024, shall comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255.
SEC. 16.Section 10123.1945 is added to the Insurance Code, immediately following Section 10123.194, to read:10123.1945.(a)(1)A disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, except for a grandfathered health plan or a qualifying health plan for a health savings account, shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy services or procedures. For a qualifying health plan for a health savings account, an insurer shall establish the plans cost sharing for vasectomy services and procedures at the minimum level necessary to preserve the insureds ability to claim tax-exempt contributions and withdrawals from the insureds health savings account under Internal Revenue Service laws, regulations, and guidance.
(2)An insurer shall not impose any restrictions or delays, including, but not limited to, prior authorization, on vasectomy services and procedures.
(3)Coverage with respect to an insured under this section shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)This section shall not be construed to deny or restrict in any way an existing right or benefit provided under law or by contract.
(c)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(d)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for vasectomy services and procedures. The exclusion from coverage under this provision shall not apply to vasectomy services or procedures for purposes other than contraception.
(1)An insurer that contracts with a religious employer to provide a disability insurance policy that does not include coverage and benefits for vasectomy services and procedures shall notify, in writing, upon initial enrollment and annually thereafter upon renewal, each enrollee that vasectomy services and procedures are not included in the insureds disability insurance policy.
(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(e)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(f)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
SEC. 17.Section 10123.196 of the Insurance Code is amended to read:10123.196.(a)An individual or group policy of disability insurance issued, amended, renewed, or delivered on or after January 1, 2000, through December 31, 2015, inclusive, that provides coverage for hospital, medical, or surgical expenses, shall provide coverage for the following, under the same terms and conditions as applicable to all benefits:
(1)A disability insurance policy that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods, as designated by the insurer. If an insureds health care provider determines that none of the methods designated by the disability insurer is medically appropriate for the insureds medical or personal history, the insurer shall, in the alternative, provide coverage for some other FDA-approved prescription contraceptive method prescribed by the patients health care provider.
(2)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for all policyholders and insureds:
(A)(i)Except as provided in clause (ii) and in subparagraphs (B) and (C) of paragraph (2), all FDA-approved, contraceptive drugs, devices, and other products, including all FDA-approved, contraceptive drugs, devices, and products available over the counter, as prescribed by the insureds provider.
(ii)For any policy described in paragraph (1) that is issued, amended, renewed, or delivered on or after January 1, 2024, both of the following conditions shall apply:
(I)A prescription shall not be required to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(II)Point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products shall be provided at in-network pharmacies without cost sharing or medical management restrictions.
(B)Voluntary tubal ligation and other similar sterilization procedures.
(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device removal.
(2)(A)Except for a grandfathered health plan, a disability insurer subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision.
(B)If the FDA has approved one or more therapeutic equivalents, as that term is defined by the FDA, of a contraceptive drug, device, or product, a disability insurer is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, an insurer shall provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the insureds provider, a disability insurer shall defer to the determination and judgment of the provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives, and ability to adhere to the appropriate use of the drug or item, as determined by the provider. The department may promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an insured, an insureds designee, or an insureds provider to request coverage of an alternative prescribed contraceptive. A request for coverage under this subparagraph that is submitted by an insured, an insureds designee, or a provider shall be approved by the disability insurer in compliance with the time limits in Section 10123.191.
(3)Except as otherwise authorized under this section, an insurer shall not infringe upon an insureds choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(c)This section shall not be construed to deny or restrict in any way any existing right or benefit provided under law or by contract.
(d)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(e)(1)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(f)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an insured by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)This subdivision shall not be construed to require a policy to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the insurers policies governing out-of-network coverage.
(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)An insurer subject to this subdivision shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply, and shall not require an insured to make any formal request for such coverage other than a pharmacy claim.
(g)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an insured.
(h)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(i)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to policies of disability insurance issued, amended, or renewed on or after January 1, 2016, health care provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
(4)For purposes of this section, over-the-counter FDA-approved contraceptive drugs, devices, and products and over-the-counter birth control methods are limited to those included as essential health benefits pursuant to Section 10112.27.
SEC. 18.Section 10127.20 is added to the Insurance Code, to read:10127.20.SEC. 18.Section 10127.09 is added to the Insurance Code, to read:10127.09.Notwithstanding any other law, a disability insurance policy that provides hospital, medical, surgical, prescription drug, or nursing benefits, except a policy providing only dental or vision benefits, that is issued, amended, renewed, or delivered, on or after January 1, 2024, and that is issued to a bona fide public or private institution of higher learning and provides coverage to its students and their dependents, or to its faculty, staff, administration, and their respective dependents, shall comply with the coverage requirements of Sections 10123.1945 and 10123.196.
SEC. 19.Section 10509.5 is added to the Public Contract Code, to read:10509.5.Notwithstanding any other law, commencing January 1, 2024, the University of California shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255 of the Health and Safety Code Sections 10123.1945 and 10123.196 of the Insurance Code.
SEC. 20.Section 10828 is added to the Public Contract Code, to read:10828.Notwithstanding any other law, commencing January 1, 2024, the California State University shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255 of the Health and Safety Code, and Sections 10123.1945 and 10123.196 of the Insurance Code.
SEC. 21.Section 14132 of the Welfare and Institutions Code is amended to read:14132.The following is the schedule of benefits under this chapter:(a)Outpatient services are covered as follows:Physician, hospital or clinic outpatient, surgical center, respiratory care, optometric, chiropractic, psychology, podiatric, occupational therapy, physical therapy, speech therapy, audiology, acupuncture to the extent federal matching funds are provided for acupuncture, and services of persons rendering treatment by prayer or healing by spiritual means in the practice of any church or religious denomination insofar as these can be encompassed by federal participation under an approved plan, subject to utilization controls.(b)(1)Inpatient hospital services, including, but not limited to, physician and podiatric services, physical therapy, and occupational therapy, are covered subject to utilization controls.(2)For a Medi-Cal fee-for-service beneficiary, emergency services and care that are necessary for the treatment of an emergency medical condition and medical care directly related to the emergency medical condition. This paragraph does not change the obligation of Medi-Cal managed care plans to provide emergency services and care. For the purposes of this paragraph, emergency services and care and emergency medical condition have the same meanings as those terms are defined in Section 1317.1 of the Health and Safety Code.(c)Nursing facility services, subacute care services, and services provided by any category of intermediate care facility for the developmentally disabled, including podiatry, physician, nurse practitioner services, and prescribed drugs, as described in subdivision (d), are covered subject to utilization controls. Respiratory care, physical therapy, occupational therapy, speech therapy, and audiology services for patients in nursing facilities and any category of intermediate care facility for persons with developmental disabilities are covered subject to utilization controls.(d)(1)Purchase of prescribed drugs is covered subject to the Medi-Cal List of Contract Drugs and utilization controls.(2)Purchase of drugs used to treat erectile dysfunction or any off-label uses of those drugs are covered only to the extent that federal financial participation is available.(3)(A)To the extent required by federal law, the purchase of outpatient prescribed drugs, for which the prescription is executed by a prescriber in written, nonelectronic form on or after April 1, 2008, is covered only when executed on a tamper resistant prescription form. The implementation of this paragraph shall conform to the guidance issued by the federal Centers for Medicare and Medicaid Services, but shall not conflict with state statutes on the characteristics of tamper resistant prescriptions for controlled substances, including Section 11162.1 of the Health and Safety Code. The department shall provide providers and beneficiaries with as much flexibility in implementing these rules as allowed by the federal government. The department shall notify and consult with appropriate stakeholders in implementing, interpreting, or making specific this paragraph.(B)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may take the actions specified in subparagraph (A) by means of a provider bulletin or notice, policy letter, or other similar instructions without taking regulatory action.(4)(A)(i)For the purposes of this paragraph, nonlegend has the same meaning as defined in subdivision (a) of Section 14105.45.(ii)Nonlegend acetaminophen-containing products, including childrens acetaminophen-containing products, selected by the department are covered benefits.(iii)Nonlegend cough and cold products selected by the department are covered benefits.(B)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may take the actions specified in subparagraph (A) by means of a provider bulletin or notice, policy letter, or other similar instruction without taking regulatory action.(e)Outpatient dialysis services and home hemodialysis services, including physician services, medical supplies, drugs, and equipment required for dialysis, are covered, subject to utilization controls.(f)Anesthesiologist services when provided as part of an outpatient medical procedure, nurse anesthetist services when rendered in an inpatient or outpatient setting under conditions set forth by the director, outpatient laboratory services, and x-ray services are covered, subject to utilization controls. This subdivision does not require prior authorization for anesthesiologist services provided as part of an outpatient medical procedure or for portable x-ray services in a nursing facility or any category of intermediate care facility for the developmentally disabled.(g)Blood and blood derivatives are covered.(h)(1)Emergency and essential diagnostic and restorative dental services, except for orthodontic, fixed bridgework, and partial dentures that are not necessary for balance of a complete artificial denture, are covered, subject to utilization controls. The utilization controls shall allow emergency and essential diagnostic and restorative dental services and prostheses that are necessary to prevent a significant disability or to replace previously furnished prostheses that are lost or destroyed due to circumstances beyond the beneficiarys control. Notwithstanding the foregoing, the director may by regulation provide for certain fixed artificial dentures necessary for obtaining employment or for medical conditions that preclude the use of removable dental prostheses, and for orthodontic services in cleft palate deformities administered by the departments California Childrens Services program.(2)For persons 21 years of age or older, the services specified in paragraph (1) shall be provided subject to the following conditions:(A)Periodontal treatment is not a benefit.(B)Endodontic therapy is not a benefit except for vital pulpotomy.(C)Laboratory processed crowns are not a benefit.(D)Removable prosthetics shall be a benefit only for patients as a requirement for employment.(E)The director may, by regulation, provide for the provision of fixed artificial dentures that are necessary for medical conditions that preclude the use of removable dental prostheses.(F)Notwithstanding the conditions specified in subparagraphs (A) to (E), inclusive, the department may approve services for persons with special medical disorders subject to utilization review.(3)Paragraph (2) shall become inoperative on July 1, 1995.(i)Medical transportation is covered, subject to utilization controls.(j)Home health care services are covered, subject to utilization controls.(k)(1)Prosthetic and orthotic devices and eyeglasses are covered, subject to utilization controls. Utilization controls shall allow replacement of prosthetic and orthotic devices and eyeglasses necessary because of loss or destruction due to circumstances beyond the beneficiarys control. Frame styles for eyeglasses replaced pursuant to this subdivision shall not change more than once every two years, unless the department so directs.(2)Orthopedic and conventional shoes are covered when provided by a prosthetic and orthotic supplier on the prescription of a physician and when at least one of the shoes will be attached to a prosthesis or brace, subject to utilization controls. Modification of stock conventional or orthopedic shoes when medically indicated is covered, subject to utilization controls. If there is a clearly established medical need that cannot be satisfied by the modification of stock conventional or orthopedic shoes, custom-made orthopedic shoes are covered, subject to utilization controls.(3)Therapeutic shoes and inserts are covered when provided to a beneficiary with a diagnosis of diabetes, subject to utilization controls, to the extent that federal financial participation is available.(l)Hearing aids are covered, subject to utilization controls. Utilization controls shall allow replacement of hearing aids necessary because of loss or destruction due to circumstances beyond the beneficiarys control.(m)Durable medical equipment and medical supplies are covered, subject to utilization controls. The utilization controls shall allow the replacement of durable medical equipment and medical supplies when necessary because of loss or destruction due to circumstances beyond the beneficiarys control. The utilization controls shall allow authorization of durable medical equipment needed to assist a disabled beneficiary in caring for a child for whom the disabled beneficiary is a parent, stepparent, foster parent, or legal guardian, subject to the availability of federal financial participation. The department shall adopt emergency regulations to define and establish criteria for assistive durable medical equipment in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(n)Family planning services are covered, subject to utilization controls. However, for Medi-Cal managed care plans, utilization controls shall be subject to Sections 1367.25 and 1367.255 of the Health and Safety Code.(o)Inpatient intensive rehabilitation hospital services, including respiratory rehabilitation services, in a general acute care hospital are covered, subject to utilization controls, when either of the following criteria are met:(1)A patient with a permanent disability or severe impairment requires an inpatient intensive rehabilitation hospital program as described in Section 14064 to develop function beyond the limited amount that would occur in the normal course of recovery.(2)A patient with a chronic or progressive disease requires an inpatient intensive rehabilitation hospital program as described in Section 14064 to maintain the patients present functional level as long as possible.(p)(1)Adult day health care is covered in accordance with Chapter 8.7 (commencing with Section 14520).(2)Commencing 30 days after the effective date of the act that added this paragraph, and notwithstanding the number of days previously approved through a treatment authorization request, adult day health care is covered for a maximum of three days per week.(3)As provided in accordance with paragraph (4), adult day health care is covered for a maximum of five days per week.(4)As of the date that the director makes the declaration described in subdivision (g) of Section 14525.1, paragraph (2) shall become inoperative and paragraph (3) shall become operative.(q)(1)Application of fluoride, or other appropriate fluoride treatment as defined by the department, and other prophylaxis treatment for children 17 years of age and under are covered.(2)All dental hygiene services provided by a registered dental hygienist, registered dental hygienist in extended functions, and registered dental hygienist in alternative practice licensed pursuant to Sections 1753, 1917, 1918, and 1922 of the Business and Professions Code may be covered as long as they are within the scope of Denti-Cal benefits and they are necessary services provided by a registered dental hygienist, registered dental hygienist in extended functions, or registered dental hygienist in alternative practice.(r)(1)Paramedic services performed by a city, county, or special district, or pursuant to a contract with a city, county, or special district, and pursuant to a program established under former Article 3 (commencing with Section 1480) of Chapter 2.5 of Division 2 of the Health and Safety Code by a paramedic certified pursuant to that article, and consisting of defibrillation and those services specified in subdivision (3) of former Section 1482 of the article.(2)A provider enrolled under this subdivision shall satisfy all applicable statutory and regulatory requirements for becoming a Medi-Cal provider.(3)This subdivision shall be implemented only to the extent funding is available under Section 14106.6.(s)(1)In-home medical care services are covered when medically appropriate and subject to utilization controls, for a beneficiary who would otherwise require care for an extended period of time in an acute care hospital at a cost higher than in-home medical care services. The director shall have the authority under this section to contract with organizations qualified to provide in-home medical care services to those persons. These services may be provided to a patient placed in a shared or congregate living arrangement, if a home setting is not medically appropriate or available to the beneficiary.(2)As used in this subdivision, in-home medical care service includes utility bills directly attributable to continuous, 24-hour operation of life-sustaining medical equipment, to the extent that federal financial participation is available.(3)As used in this subdivision, in-home medical care services include, but are not limited to:(A)Level-of-care and cost-of-care evaluations.(B)Expenses, directly attributable to home care activities, for materials.(C)Physician fees for home visits.(D)Expenses directly attributable to home care activities for shelter and modification to shelter.(E)Expenses directly attributable to additional costs of special diets, including tube feeding.(F)Medically related personal services.(G)Home nursing education.(H)Emergency maintenance repair.(I)Home health agency personnel benefits that permit coverage of care during periods when regular personnel are on vacation or using sick leave.(J)All services needed to maintain antiseptic conditions at stoma or shunt sites on the body.(K)Emergency and nonemergency medical transportation.(L)Medical supplies.(M)Medical equipment, including, but not limited to, scales, gurneys, and equipment racks suitable for paralyzed patients.(N)Utility use directly attributable to the requirements of home care activities that are in addition to normal utility use.(O)Special drugs and medications.(P)Home health agency supervision of visiting staff that is medically necessary, but not included in the home health agency rate.(Q)Therapy services.(R)Household appliances and household utensil costs directly attributable to home care activities.(S)Modification of medical equipment for home use.(T)Training and orientation for use of life-support systems, including, but not limited to, support of respiratory functions.(U)Respiratory care practitioner services as defined in Sections 3702 and 3703 of the Business and Professions Code, subject to prescription by a physician and surgeon.(4)A beneficiary receiving in-home medical care services is entitled to the full range of services within the Medi-Cal scope of benefits as defined by this section, subject to medical necessity and applicable utilization control. Services provided pursuant to this subdivision, which are not otherwise included in the Medi-Cal schedule of benefits, shall be available only to the extent that federal financial participation for these services is available in accordance with a home- and community-based services waiver.(t)Home- and community-based services approved by the United States Department of Health and Human Services are covered to the extent that federal financial participation is available for those services under the state plan or waivers granted in accordance with Section 1315 or 1396n of Title 42 of the United States Code. The director may seek waivers for any or all home- and community-based services approvable under Section 1315 or 1396n of Title 42 of the United States Code. Coverage for those services shall be limited by the terms, conditions, and duration of the federal waivers.(u)Comprehensive perinatal services, as provided through an agreement with a health care provider designated in Section 14134.5 and meeting the standards developed by the department pursuant to Section 14134.5, subject to utilization controls.The department shall seek any federal waivers necessary to implement the provisions of this subdivision. The provisions for which appropriate federal waivers cannot be obtained shall not be implemented. Provisions for which waivers are obtained or for which waivers are not required shall be implemented notwithstanding any inability to obtain federal waivers for the other provisions. No provision of this subdivision shall be implemented unless matching funds from Subchapter XIX (commencing with Section 1396) of Chapter 7 of Title 42 of the United States Code are available.(v)Early and periodic screening, diagnosis, and treatment for any individual under 21 years of age is covered, consistent with the requirements of Subchapter XIX (commencing with Section 1396) of Chapter 7 of Title 42 of the United States Code.(w)Hospice service that is Medicare-certified hospice service is covered, subject to utilization controls. Coverage shall be available only to the extent that no additional net program costs are incurred.(x)When a claim for treatment provided to a beneficiary includes both services that are authorized and reimbursable under this chapter and services that are not reimbursable under this chapter, that portion of the claim for the treatment and services authorized and reimbursable under this chapter shall be payable.(y)Home- and community-based services approved by the United States Department of Health and Human Services for a beneficiary with a diagnosis of Acquired Immune Deficiency Syndrome (AIDS) or AIDS-related complex, who requires intermediate care or a higher level of care.Services provided pursuant to a waiver obtained from the Secretary of the United States Department of Health and Human Services pursuant to this subdivision, and that are not otherwise included in the Medi-Cal schedule of benefits, shall be available only to the extent that federal financial participation for these services is available in accordance with the waiver, and subject to the terms, conditions, and duration of the waiver. These services shall be provided to a beneficiary in accordance with the clients needs as identified in the plan of care, and subject to medical necessity and applicable utilization control.The director may, under this section, contract with organizations qualified to provide, directly or by subcontract, services provided for in this subdivision to an eligible beneficiary. Contracts or agreements entered into pursuant to this division shall not be subject to the Public Contract Code.(z)Respiratory care when provided in organized health care systems as defined in Section 3701 of the Business and Professions Code, and as an in-home medical service as outlined in subdivision (s).(aa)(1)There is hereby established in the department a program to provide comprehensive clinical family planning services to any person who has a family income at or below 200 percent of the federal poverty level, as revised annually, and who is eligible to receive these services pursuant to the waiver identified in paragraph (2). This program shall be known as the Family Planning, Access, Care, and Treatment (Family PACT) Program.(2)The department shall seek a waiver in accordance with Section 1315 of Title 42 of the United States Code, or a state plan amendment adopted in accordance with Section 1396a(a)(10)(A)(ii)(XXI) of Title 42 of the United States Code, which was added to Section 1396a of Title 42 of the United States Code by Section 2303(a)(2) of the federal Patient Protection and Affordable Care Act (PPACA) (Public Law 111-148), for a program to provide comprehensive clinical family planning services as described in paragraph (8). Under the waiver, the program shall be operated only in accordance with the waiver and the statutes and regulations in paragraph (4) and subject to the terms, conditions, and duration of the waiver. Under the state plan amendment, which shall replace the waiver and shall be known as the Family PACT successor state plan amendment, the program shall be operated only in accordance with this subdivision and the statutes and regulations in paragraph (4). The state shall use the standards and processes imposed by the state on January 1, 2007, including the application of an eligibility discount factor to the extent required by the federal Centers for Medicare and Medicaid Services, for purposes of determining eligibility as permitted under Section 1396a(a)(10)(A)(ii)(XXI) of Title 42 of the United States Code. To the extent that federal financial participation is available, the program shall continue to conduct education, outreach, enrollment, service delivery, and evaluation services as specified under the waiver. The services shall be provided under the program only if the waiver and, when applicable, the successor state plan amendment are approved by the federal Centers for Medicare and Medicaid Services and only to the extent that federal financial participation is available for the services. This section does not prohibit the department from seeking the Family PACT successor state plan amendment during the operation of the waiver.(3)Solely for the purposes of the waiver or Family PACT successor state plan amendment and notwithstanding any other law, the collection and use of an individuals social security number shall be necessary only to the extent required by federal law.(4)Sections 14105.3 to 14105.39, inclusive, 14107.11, 24005, and 24013, and any regulations adopted under these statutes shall apply to the program provided for under this subdivision. No other law under the Medi-Cal program or the State-Only Family Planning Program shall apply to the program provided for under this subdivision.(5)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, without taking regulatory action, the provisions of the waiver after its approval by the federal Centers for Medicare and Medicaid Services and the provisions of this section by means of an all-county letter or similar instruction to providers. Thereafter, the department shall adopt regulations to implement this section and the approved waiver in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. Beginning six months after the effective date of the act adding this subdivision, the department shall provide a status report to the Legislature on a semiannual basis until regulations have been adopted.(6)If the Department of Finance determines that the program operated under the authority of the waiver described in paragraph (2) or the Family PACT successor state plan amendment is no longer cost effective, this subdivision shall become inoperative on the first day of the first month following the issuance of a 30-day notification of that determination in writing by the Department of Finance to the chairperson in each house that considers appropriations, the chairpersons of the committees, and the appropriate subcommittees in each house that considers the State Budget, and the Chairperson of the Joint Legislative Budget Committee.(7)If this subdivision ceases to be operative, all persons who have received or are eligible to receive comprehensive clinical family planning services pursuant to the waiver described in paragraph (2) shall receive family planning services under the Medi-Cal program pursuant to subdivision (n) if they are otherwise eligible for Medi-Cal with no share of cost, or shall receive comprehensive clinical family planning services under the program established in Division 24 (commencing with Section 24000) either if they are eligible for Medi-Cal with a share of cost or if they are otherwise eligible under Section 24003.(8)For purposes of this subdivision, comprehensive clinical family planning services means the process of establishing objectives for the number and spacing of children, and selecting the means by which those objectives may be achieved. These means include a broad range of acceptable and effective methods and services to limit or enhance fertility, including contraceptive methods, federal Food and Drug Administration-approved contraceptive drugs, devices, and supplies, natural family planning, abstinence methods, and basic, limited fertility management. Comprehensive clinical family planning services include, but are not limited to, preconception counseling, maternal and fetal health counseling, general reproductive health care, including diagnosis and treatment of infections and conditions, including cancer, that threaten reproductive capability, medical family planning treatment and procedures, including supplies and followup, and informational, counseling, and educational services. Comprehensive clinical family planning services shall not include abortion, pregnancy testing solely for the purposes of referral for abortion or services ancillary to abortions, or pregnancy care that is not incident to the diagnosis of pregnancy. Comprehensive clinical family planning services shall be subject to utilization control and include all of the following:(A)Family planning related services and male and female sterilization. Family planning services for men and women shall include emergency services and services for complications directly related to the contraceptive method, federal Food and Drug Administration-approved contraceptive drugs, devices, and supplies, and followup, consultation, and referral services, as indicated, which may require treatment authorization requests.(B)All United States Department of Agriculture, federal Food and Drug Administration-approved contraceptive drugs, devices, and supplies that are in keeping with current standards of practice and from which the individual may choose.(C)Culturally and linguistically appropriate health education and counseling services, including informed consent, that include all of the following:(i)Psychosocial and medical aspects of contraception.(ii)Sexuality.(iii)Fertility.(iv)Pregnancy.(v)Parenthood.(vi)Infertility.(vii)Reproductive health care.(viii)Preconception and nutrition counseling.(ix)Prevention and treatment of sexually transmitted infection.(x)Use of contraceptive methods, federal Food and Drug Administration-approved contraceptive drugs, devices, and supplies.(xi)Possible contraceptive consequences and followup.(xii)Interpersonal communication and negotiation of relationships to assist individuals and couples in effective contraceptive method use and planning families.(D)A comprehensive health history, updated at the next periodic visit (between 11 and 24 months after initial examination) that includes a complete obstetrical history, gynecological history, contraceptive history, personal medical history, health risk factors, and family health history, including genetic or hereditary conditions.(E)A complete physical examination on initial and subsequent periodic visits.(F)Services, drugs, devices, and supplies deemed by the federal Centers for Medicare and Medicaid Services to be appropriate for inclusion in the program.(G)(i)Home test kits for sexually transmitted diseases, including any laboratory costs of processing the kit, that are deemed medically necessary or appropriate and ordered directly by an enrolled Medi-Cal or Family PACT clinician or furnished through a standing order for patient use based on clinical guidelines and individual patient health needs.(ii)For purposes of this subparagraph, home test kit means a product used for a test recommended by the federal Centers for Disease Control and Prevention guidelines or the United States Preventive Services Task Force that has been CLIA-waived, FDA-cleared or -approved, or developed by a laboratory in accordance with established regulations and quality standards, to allow individuals to self-collect specimens for STDs, including HIV, remotely at a location outside of a clinical setting.(iii)Reimbursement under this subparagraph shall be contingent upon the addition of codes specific to home test kits in the Current Procedural Terminology or Healthcare Common Procedure Coding System to comply with Health Insurance Portability and Accountability Act requirements. The home test kit shall be sent by the enrolled Family PACT provider to a Medi-Cal-enrolled laboratory with fee based on Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule.(9)In order to maximize the availability of federal financial participation under this subdivision, the director shall have the discretion to implement the Family PACT successor state plan amendment retroactively to July 1, 2010.(ab)(1)Purchase of prescribed enteral nutrition products is covered, subject to the Medi-Cal list of enteral nutrition products and utilization controls.(2)Purchase of enteral nutrition products is limited to those products to be administered through a feeding tube, including, but not limited to, a gastric, nasogastric, or jejunostomy tube. A beneficiary under the Early and Periodic Screening, Diagnostic, and Treatment Program shall be exempt from this paragraph.(3)Notwithstanding paragraph (2), the department may deem an enteral nutrition product, not administered through a feeding tube, including, but not limited to, a gastric, nasogastric, or jejunostomy tube, a benefit for patients with diagnoses, including, but not limited to, malabsorption and inborn errors of metabolism, if the product has been shown to be neither investigational nor experimental when used as part of a therapeutic regimen to prevent serious disability or death.(4)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement the amendments to this subdivision made by the act that added this paragraph by means of all-county letters, provider bulletins, or similar instructions, without taking regulatory action.(5)The amendments made to this subdivision by the act that added this paragraph shall be implemented June 1, 2011, or on the first day of the first calendar month following 60 days after the date the department secures all necessary federal approvals to implement this section, whichever is later.(ac)Diabetic testing supplies are covered when provided by a pharmacy, subject to utilization controls.(ad)(1)Nonmedical transportation is covered, subject to utilization controls and permissible time and distance standards, for a beneficiary to obtain covered Medi-Cal services.(2)(A)(i)Nonmedical transportation includes, at a minimum, round trip transportation for a beneficiary to obtain covered Medi-Cal services by passenger car, taxicab, or any other form of public or private conveyance, and mileage reimbursement when conveyance is in a private vehicle arranged by the beneficiary and not through a transportation broker, bus passes, taxi vouchers, or train tickets.(ii)Nonmedical transportation does not include the transportation of a sick, injured, invalid, convalescent, infirm, or otherwise incapacitated beneficiary by ambulance, litter van, or wheelchair van licensed, operated, and equipped in accordance with state and local statutes, ordinances, or regulations.(B)Nonmedical transportation shall be provided for a beneficiary who can attest in a manner to be specified by the department that other currently available resources have been reasonably exhausted. For a beneficiary enrolled in a managed care plan, nonmedical transportation shall be provided by the beneficiarys managed care plan. For a Medi-Cal fee-for-service beneficiary, the department shall provide nonmedical transportation when those services are not available to the beneficiary under Sections 14132.44 and 14132.47.(3)Nonmedical transportation shall be provided in a form and manner that is accessible, in terms of physical and geographic accessibility, for the beneficiary and consistent with applicable state and federal disability rights laws.(4)It is the intent of the Legislature in enacting this subdivision to affirm the requirement under Section 431.53 of Title 42 of the Code of Federal Regulations, in which the department is required to provide necessary transportation, including nonmedical transportation, for recipients to and from covered services. This subdivision shall not be interpreted to add a new benefit to the Medi-Cal program.(5)The department shall seek any federal approvals that may be required to implement this subdivision, including, but not limited to, approval of revisions to the existing state plan that the department determines are necessary to implement this subdivision.(6)This subdivision shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized and any necessary federal approvals have been obtained.(7)Prior to the effective date of any necessary federal approvals, nonmedical transportation was not a Medi-Cal managed care benefit with the exception of when provided as an Early and Periodic Screening, Diagnostic, and Treatment service.(8)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this subdivision by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted. By July 1, 2018, the department shall adopt regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. Commencing January 1, 2018, and notwithstanding Section 10231.5 of the Government Code, the department shall provide a status report to the Legislature on a semiannual basis, in compliance with Section 9795 of the Government Code, until regulations have been adopted.(9)This subdivision shall not be implemented until July 1, 2017.(ae)(1)No sooner than January 1, 2022, Rapid Whole Genome Sequencing, including individual sequencing, trio sequencing for a parent or parents and their baby, and ultra-rapid sequencing, is a covered benefit for any Medi-Cal beneficiary who is one year of age or younger and is receiving inpatient hospital services in an intensive care unit.(2)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this subdivision by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted.(3)This subdivision shall be implemented only to the extent that any necessary federal approvals are obtained, and federal financial participation is available and not otherwise jeopardized.(af)(1)Home test kits for sexually transmitted diseases that are deemed medically necessary or appropriate and ordered directly by an enrolled Medi-Cal clinician or furnished through a standing order for patient use based on clinical guidelines and individual patient health needs.(2)For purposes of this subdivision, home test kit means a product used for a test recommended by the federal Centers for Disease Control and Prevention guidelines or the United States Preventive Services Task Force that has been CLIA-waived, FDA-cleared or -approved, or developed by a laboratory in accordance with established regulations and quality standards, to allow individuals to self-collect specimens for STDs, including HIV, remotely at a location outside of a clinical setting.(3)Reimbursement under this subparagraph shall be contingent upon the addition of codes specific to home test kits in the Current Procedural Terminology or Healthcare Common Procedure Coding System to comply with Health Insurance Portability and Accountability Act requirements. The home test kit shall be sent by the enrolled Medi-Cal provider to a Medi-Cal-enrolled laboratory with fee based on Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule.(4)This subdivision shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.(5)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the State Department of Health Care Services may implement this subdivision by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, without taking any further regulatory action.SEC. 22.SEC. 21.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
SEC. 22.Section 5.5 of this bill incorporates amendments to Section 12926 of the Government Code proposed by both this bill and Assembly Bill 1766. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2023, (2) each bill amends Section 12926 of the Government Code, and (3) this bill is enacted after Assembly Bill 1766, in which case Section 5 of this bill shall not become operative.
SEC. 23.Section 6.5 of this bill incorporates amendments to Section 12931 of the Government Code proposed by both this bill and Assembly Bill 2960. That section shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2023, (2) each bill amends Section 12931 of the Government Code, and (3) this bill is enacted after Assembly Bill 2960, in which case Section 6 of this bill shall not become operative.
This act shall be known, and may be cited, as the Contraceptive Equity Act of 2021. 2022.
SEC. 2.The Legislature finds and declares all of the following:
(a)California has a long history of expanding timely access to birth control to prevent unintended pregnancy. Thanks to a combination of innovative policies and programs enacted statewide, unintended pregnancy rates are at a 30-year low.
(b)Despite the progress made, health disparities in reproductive health outcomes persist among Black, Indigenous and People of Color, including disproportionate unintended pregnancy, infant and maternal mortality, and sexually transmitted infection rates. The Legislature must take action to ensure that all Californians have equitable access to preventive contraceptive care.
(c)The federal Patient Protection and Affordable Care Act (Public Law 111-148) included a mandate that most health insurance plans cover contraception without out-of-pocket costs for patients.
(d)Californias Contraceptive Coverage Equity Act of 2014 and the Annual Supply of Contraceptives Act of 2016, built on this federal policy and existing state law to be the first state in the country to require coverage of birth control methods approved by the federal Food and Drug Administration for women without cost sharing or restrictions and a 12-month supply of self-administered birth control dispensed at one time for individuals enrolled in health insurance plans and policies regulated by the Knox-Keene Health Care Service Plan Act of 1975.
(e)Since 2014, several other states have expanded on Californias model legislation to create more equitable contraceptive coverage and access by requiring most health insurance plans and policies to cover voluntary sterilization services and all birth control methods available over-the-counter without a prescription for all beneficiaries, regardless of gender.
(f)A report by the Guttmacher Institute shows that vasectomy is among the most effective and cost-effective contraceptive methods available.
(g)Trump-era attacks on birth control access have underscored the need to codify the expansion of contraceptive coverage for as many Californians as possible under state law.
(h)The COVID-19 public health emergency has also further illuminated the structural inequities that disproportionately affect youth, low-income people and communities of color in accessing birth control services. A report by the Guttmacher Institute revealed that 29 percent of White women, 38 percent of Black women and 45 percent of Latinas now face difficulties accessing birth control as a result of the pandemic.
(i)The Legislature intends to reduce sexual and reproductive health disparities and ensure greater health equity by providing a pathway for more Californians to get the contraceptive care they want, when they need it without inequitable delays or cost barriers.
(j)The Legislature intends for the relevant California departments and agencies to work in concert to ensure compliance with these provisions.
SEC. 3.Section 12920 of the Government Code is amended to read:12920.It is hereby declared as the public policy of this state that it is necessary to protect and safeguard the right and opportunity of all persons to seek, obtain, and hold employment without discrimination or abridgment on account of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or military and veteran status.
It is recognized that the practice of denying employment opportunity and discriminating in the terms of employment for these reasons foments domestic strife and unrest, deprives the state of the fullest utilization of its capacities for development and advancement, and substantially and adversely affects the interests of employees, employers, and the public in general.
Further, the practice of discrimination because of race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, familial status, source of income, disability, veteran or military status, or genetic information in housing accommodations is declared to be against public policy.
It is the purpose of this part to provide effective remedies that will eliminate these discriminatory practices.
This part shall be deemed an exercise of the police power of the state for the protection of the welfare, health, and peace of the people of this state.
SEC. 4.Section 12921 of the Government Code is amended to read:12921.(a)The opportunity to seek, obtain, and hold employment without discrimination because of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status is hereby recognized as and declared to be a civil right.
(b)The opportunity to seek, obtain, and hold housing without discrimination because of race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, familial status, source of income, disability, veteran or military status, genetic information, or any other basis prohibited by Section 51 of the Civil Code is hereby recognized as and declared to be a civil right.
SEC. 5.Section 12926 of the Government Code is amended to read:12926.As used in this part in connection with unlawful practices, unless a different meaning clearly appears from the context:
(a)Affirmative relief or prospective relief includes the authority to order reinstatement of an employee, awards of backpay, reimbursement of out-of-pocket expenses, hiring, transfers, reassignments, grants of tenure, promotions, cease and desist orders, posting of notices, training of personnel, testing, expunging of records, reporting of records, and any other similar relief that is intended to correct unlawful practices under this part.
(b)Age refers to the chronological age of any individual who has reached a 40th birthday.
(c)Except as provided by Section 12926.05, employee does not include any individual employed by that persons parent, spouse, or child or any individual employed under a special license in a nonprofit sheltered workshop or rehabilitation facility.
(d)Employer includes any person regularly employing five or more persons, or any person acting as an agent of an employer, directly or indirectly, the state or any political or civil subdivision of the state, and cities, except as follows:
Employer does not include a religious association or corporation not organized for private profit.
(e)Employment agency includes any person undertaking for compensation to procure employees or opportunities to work.
(f)Essential functions means the fundamental job duties of the employment position the individual with a disability holds or desires. Essential functions does not include the marginal functions of the position.
(1)A job function may be considered essential for any of several reasons, including, but not limited to, any one or more of the following:
(A)The function may be essential because the reason the position exists is to perform that function.
(B)The function may be essential because of the limited number of employees available among whom the performance of that job function can be distributed.
(C)The function may be highly specialized, so that the incumbent in the position is hired based on expertise or the ability to perform a particular function.
(2)Evidence of whether a particular function is essential includes, but is not limited to, the following:
(A)The employers judgment as to which functions are essential.
(B)Written job descriptions prepared before advertising or interviewing applicants for the job.
(C)The amount of time spent on the job performing the function.
(D)The consequences of not requiring the incumbent to perform the function.
(E)The terms of a collective bargaining agreement.
(F)The work experiences of past incumbents in the job.
(G)The current work experience of incumbents in similar jobs.
(g)(1)Genetic information means, with respect to any individual, information about any of the following:
(A)The individuals genetic tests.
(B)The genetic tests of family members of the individual.
(C)The manifestation of a disease or disorder in family members of the individual.
(2)Genetic information includes any request for, or receipt of, genetic services, or participation in clinical research that includes genetic services, by an individual or any family member of the individual.
(3)Genetic information does not include information about the sex or age of any individual.
(h)Labor organization includes any organization that exists and is constituted for the purpose, in whole or in part, of collective bargaining or of dealing with employers concerning grievances, terms or conditions of employment, or of other mutual aid or protection.
(i)Medical condition means either of the following:
(1)Any health impairment related to or associated with a diagnosis of cancer or a record or history of cancer.
(2)Genetic characteristics. For purposes of this section, genetic characteristics means either of the following:
(A)Any scientifically or medically identifiable gene or chromosome, or combination or alteration thereof, that is known to be a cause of a disease or disorder in a person or that persons offspring, or that is determined to be associated with a statistically increased risk of development of a disease or disorder, and that is presently not associated with any symptoms of any disease or disorder.
(B)Inherited characteristics that may derive from the individual or family member, that are known to be a cause of a disease or disorder in a person or that persons offspring, or that are determined to be associated with a statistically increased risk of development of a disease or disorder, and that are presently not associated with any symptoms of any disease or disorder.
(j)Mental disability includes, but is not limited to, all of the following:
(1)Having any mental or psychological disorder or condition, such as intellectual disability, organic brain syndrome, emotional or mental illness, or specific learning disabilities, that limits a major life activity. For purposes of this section:
(A)Limits shall be determined without regard to mitigating measures, such as medications, assistive devices, or reasonable accommodations, unless the mitigating measure itself limits a major life activity.
(B)A mental or psychological disorder or condition limits a major life activity if it makes the achievement of the major life activity difficult.
(C)Major life activities shall be broadly construed and shall include physical, mental, and social activities and working.
(2)Any other mental or psychological disorder or condition not described in paragraph (1) that requires special education or related services.
(3)Having a record or history of a mental or psychological disorder or condition described in paragraph (1) or (2), which is known to the employer or other entity covered by this part.
(4)Being regarded or treated by the employer or other entity covered by this part as having, or having had, any mental condition that makes achievement of a major life activity difficult.
(5)Being regarded or treated by the employer or other entity covered by this part as having, or having had, a mental or psychological disorder or condition that has no present disabling effect, but that may become a mental disability as described in paragraph (1) or (2).
Mental disability does not include sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from the current unlawful use of controlled substances or other drugs.
(k)Veteran or military status means a member or veteran of the United States Armed Forces, United States Armed Forces Reserve, the United States National Guard, and the California National Guard.
(l)On the bases enumerated in this part means or refers to discrimination on the basis of one or more of the following: race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, sexual orientation, reproductive health decisionmaking, or veteran or military status.
(m)Physical disability includes, but is not limited to, all of the following:
(1)Having any physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss that does both of the following:
(A)Affects one or more of the following body systems: neurological, immunological, musculoskeletal, special sense organs, respiratory, including speech organs, cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine.
(B)Limits a major life activity. For purposes of this section:
(i)Limits shall be determined without regard to mitigating measures such as medications, assistive devices, prosthetics, or reasonable accommodations, unless the mitigating measure itself limits a major life activity.
(ii)A physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss limits a major life activity if it makes the achievement of the major life activity difficult.
(iii)Major life activities shall be broadly construed and includes physical, mental, and social activities and working.
(2)Any other health impairment not described in paragraph (1) that requires special education or related services.
(3)Having a record or history of a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment described in paragraph (1) or (2), which is known to the employer or other entity covered by this part.
(4)Being regarded or treated by the employer or other entity covered by this part as having, or having had, any physical condition that makes achievement of a major life activity difficult.
(5)Being regarded or treated by the employer or other entity covered by this part as having, or having had, a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment that has no present disabling effect but may become a physical disability as described in paragraph (1) or (2).
(6)Physical disability does not include sexual behavior disorders, compulsive gambling, kleptomania, pyromania, or psychoactive substance use disorders resulting from the current unlawful use of controlled substances or other drugs.
(n)Notwithstanding subdivisions (j) and (m), if the definition of disability used in the federal Americans with Disabilities Act of 1990 (Public Law 101-336) would result in broader protection of the civil rights of individuals with a mental disability or physical disability, as defined in subdivision (j) or (m), or would include any medical condition not included within those definitions, then that broader protection or coverage shall be deemed incorporated by reference into, and shall prevail over conflicting provisions of, the definitions in subdivisions (j) and (m).
(o)Race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, sexual orientation, reproductive health decisionmaking, or veteran or military status includes a perception that the person has any of those characteristics or that the person is associated with a person who has, or is perceived to have, any of those characteristics.
(p)Reasonable accommodation may include either of the following:
(1)Making existing facilities used by employees readily accessible to, and usable by, individuals with disabilities.
(2)Job restructuring, part-time or modified work schedules, reassignment to a vacant position, acquisition or modification of equipment or devices, adjustment or modifications of examinations, training materials or policies, the provision of qualified readers or interpreters, and other similar accommodations for individuals with disabilities.
(q)Religious creed, religion, religious observance, religious belief, and creed include all aspects of religious belief, observance, and practice, including religious dress and grooming practices. Religious dress practice shall be construed broadly to include the wearing or carrying of religious clothing, head or face coverings, jewelry, artifacts, and any other item that is part of an individual observing a religious creed. Religious grooming practice shall be construed broadly to include all forms of head, facial, and body hair that are part of an individual observing a religious creed.
(r)(1)Sex includes, but is not limited to, the following:
(A)Pregnancy or medical conditions related to pregnancy.
(B)Childbirth or medical conditions related to childbirth.
(C)Breastfeeding or medical conditions related to breastfeeding.
(2)Sex also includes, but is not limited to, a persons gender. Gender means sex, and includes a persons gender identity and gender expression. Gender expression means a persons gender-related appearance and behavior whether or not stereotypically associated with the persons assigned sex at birth.
(s)Sexual orientation means heterosexuality, homosexuality, and bisexuality.
(t)Supervisor means any individual having the authority, in the interest of the employer, to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline other employees, or the responsibility to direct them, or to adjust their grievances, or effectively to recommend that action, if, in connection with the foregoing, the exercise of that authority is not of a merely routine or clerical nature, but requires the use of independent judgment.
(u)Undue hardship means an action requiring significant difficulty or expense, when considered in light of the following factors:
(1)The nature and cost of the accommodation needed.
(2)The overall financial resources of the facilities involved in the provision of the reasonable accommodations, the number of persons employed at the facility, and the effect on expenses and resources or the impact otherwise of these accommodations upon the operation of the facility.
(3)The overall financial resources of the covered entity, the overall size of the business of a covered entity with respect to the number of employees, and the number, type, and location of its facilities.
(4)The type of operations, including the composition, structure, and functions of the workforce of the entity.
(5)The geographic separateness or administrative or fiscal relationship of the facility or facilities.
(v)National origin discrimination includes, but is not limited to, discrimination on the basis of possessing a drivers license granted under Section 12801.9 of the Vehicle Code.
(w)Race is inclusive of traits historically associated with race, including, but not limited to, hair texture and protective hairstyles.
(x)Protective hairstyles includes, but is not limited to, such hairstyles as braids, locks, and twists.
(y)Reproductive health decisionmaking includes, but is not limited to, a decision to use or access a particular drug, device, product, or medical service for reproductive health. This subdivision and other provisions in this part relating to reproductive health care decisionmaking shall not be construed to mean that subdivision (r) of this section and other provisions in this part related to sex do not include reproductive health decisionmaking.
SEC. 6.Section 12931 of the Government Code is amended to read:12931.The department may also provide assistance to communities and persons therein in resolving disputes, disagreements, or difficulties relating to discriminatory practices based on race, religious creed, color, national origin, ancestry, physical disability, mental disability, veteran or military status, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, familial status, age, reproductive health decisionmaking, or sexual orientation that impair the rights of persons in those communities under the Constitution or laws of the United States or of this state. The services of the department may be made available in cases of these disputes, disagreements, or difficulties only when, in its judgment, peaceful relations among the citizens of the community involved are threatened thereby. The departments services are to be made available only upon the request of an appropriate state or local public body, or upon the request of any person directly affected by any such dispute, disagreement, or difficulty.
The assistance of the department pursuant to this section shall be limited to endeavors at investigation, conference, conciliation, and persuasion.
SEC. 7.Section 12940 of the Government Code, as amended by Section 36 of Chapter 48 of the Statutes of 2022, is amended to read:12940.It is an unlawful employment practice, unless based upon a bona fide occupational qualification, or, except where based upon applicable security regulations established by the United States or the State of California:
(a)For an employer, because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decisionmaking, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, or veteran or military status of any person, to refuse to hire or employ the person or to refuse to select the person for a training program leading to employment, or to bar or to discharge the person from employment or from a training program leading to employment, or to discriminate against the person in compensation or in terms, conditions, or privileges of employment.
(1)This part does not prohibit an employer from refusing to hire or discharging an employee with a physical or mental disability, or subject an employer to any legal liability resulting from the refusal to employ or the discharge of an employee with a physical or mental disability, if the employee, because of a physical or mental disability, is unable to perform the employees essential duties even with reasonable accommodations, or cannot perform those duties in a manner that would not endanger the employees health or safety or the health or safety of others even with reasonable accommodations.
(2)This part does not prohibit an employer from refusing to hire or discharging an employee who, because of the employees medical condition, is unable to perform the employees essential duties even with reasonable accommodations, or cannot perform those duties in a manner that would not endanger the employees health or safety or the health or safety of others even with reasonable accommodations. Nothing in this part shall subject an employer to any legal liability resulting from the refusal to employ or the discharge of an employee who, because of the employees medical condition, is unable to perform the employees essential duties, or cannot perform those duties in a manner that would not endanger the employees health or safety or the health or safety of others even with reasonable accommodations.
(3)Nothing in this part relating to discrimination on account of marital status shall do either of the following:
(A)Affect the right of an employer to reasonably regulate, for reasons of supervision, safety, security, or morale, the working of spouses in the same department, division, or facility, consistent with the rules and regulations adopted by the council.
(B)Prohibit bona fide health plans from providing additional or greater benefits to employees with dependents than to those employees without or with fewer dependents.
(4)Nothing in this part relating to discrimination on account of sex shall affect the right of an employer to use veteran status as a factor in employee selection or to give special consideration to Vietnam-era veterans.
(5)(A)This part does not prohibit an employer from refusing to employ an individual because of the individuals age if the law compels or provides for that refusal. Promotions within the existing staff, hiring or promotion on the basis of experience and training, rehiring on the basis of seniority and prior service with the employer, or hiring under an established recruiting program from high schools, colleges, universities, or trade schools do not, in and of themselves, constitute unlawful employment practices.
(B)The provisions of this part relating to discrimination on the basis of age do not prohibit an employer from providing health benefits or health care reimbursement plans to retired persons that are altered, reduced, or eliminated when the person becomes eligible for Medicare health benefits. This subparagraph applies to all retiree health benefit plans and contractual provisions or practices concerning retiree health benefits and health care reimbursement plans in effect on or after January 1, 2011.
(b)For a labor organization, because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status of any person, to exclude, expel, or restrict from its membership the person, or to provide only second-class or segregated membership or to discriminate against any person because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status of the person in the election of officers of the labor organization or in the selection of the labor organizations staff or to discriminate in any way against any of its members or against any employer or against any person employed by an employer.
(c)For any person to discriminate against any person in the selection, termination, training, or other terms or treatment of that person in any apprenticeship training program, any other training program leading to employment, an unpaid internship, or another limited duration program to provide unpaid work experience for that person because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status of the person discriminated against.
(d)For any employer or employment agency to print or circulate or cause to be printed or circulated any publication, or to make any nonjob-related inquiry of an employee or applicant, either verbal or through use of an application form, that expresses, directly or indirectly, any limitation, specification, or discrimination as to race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status, or any intent to make any such limitation, specification, or discrimination. This part does not prohibit an employer or employment agency from inquiring into the age of an applicant, or from specifying age limitations, if the law compels or provides for that action.
(e)(1)Except as provided in paragraph (2) or (3), for any employer or employment agency to require any medical or psychological examination of an applicant, to make any medical or psychological inquiry of an applicant, to make any inquiry whether an applicant has a mental disability or physical disability or medical condition, or to make any inquiry regarding the nature or severity of a physical disability, mental disability, or medical condition.
(2)Notwithstanding paragraph (1), an employer or employment agency may inquire into the ability of an applicant to perform job-related functions and may respond to an applicants request for reasonable accommodation.
(3)Notwithstanding paragraph (1), an employer or employment agency may require a medical or psychological examination or make a medical or psychological inquiry of a job applicant after an employment offer has been made but prior to the commencement of employment duties, provided that the examination or inquiry is job related and consistent with business necessity and that all entering employees in the same job classification are subject to the same examination or inquiry.
(f)(1)Except as provided in paragraph (2), for any employer or employment agency to require any medical or psychological examination of an employee, to make any medical or psychological inquiry of an employee, to make any inquiry whether an employee has a mental disability, physical disability, or medical condition, or to make any inquiry regarding the nature or severity of a physical disability, mental disability, or medical condition.
(2)Notwithstanding paragraph (1), an employer or employment agency may require any examinations or inquiries that it can show to be job related and consistent with business necessity. An employer or employment agency may conduct voluntary medical examinations, including voluntary medical histories, which are part of an employee health program available to employees at that worksite.
(g)For any employer, labor organization, or employment agency to harass, discharge, expel, or otherwise discriminate against any person because the person has made a report pursuant to Section 11161.8 of the Penal Code that prohibits retaliation against hospital employees who report suspected patient abuse by health facilities or community care facilities.
(h)For any employer, labor organization, employment agency, or person to discharge, expel, or otherwise discriminate against any person because the person has opposed any practices forbidden under this part or because the person has filed a complaint, testified, or assisted in any proceeding under this part.
(i)For any person to aid, abet, incite, compel, or coerce the doing of any of the acts forbidden under this part, or to attempt to do so.
(j)(1)For an employer, labor organization, employment agency, apprenticeship training program or any training program leading to employment, or any other person, because of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, reproductive health decisionmaking, or veteran or military status, to harass an employee, an applicant, an unpaid intern or volunteer, or a person providing services pursuant to a contract. Harassment of an employee, an applicant, an unpaid intern or volunteer, or a person providing services pursuant to a contract by an employee, other than an agent or supervisor, shall be unlawful if the entity, or its agents or supervisors, knows or should have known of this conduct and fails to take immediate and appropriate corrective action. An employer may also be responsible for the acts of nonemployees, with respect to harassment of employees, applicants, unpaid interns or volunteers, or persons providing services pursuant to a contract in the workplace, if the employer, or its agents or supervisors, knows or should have known of the conduct and fails to take immediate and appropriate corrective action. In reviewing cases involving the acts of nonemployees, the extent of the employers control and any other legal responsibility that the employer may have with respect to the conduct of those nonemployees shall be considered. An entity shall take all reasonable steps to prevent harassment from occurring. Loss of tangible job benefits shall not be necessary in order to establish harassment.
(2)The provisions of this subdivision are declaratory of existing law, except for the new duties imposed on employers with regard to harassment.
(3)An employee of an entity subject to this subdivision is personally liable for any harassment prohibited by this section that is perpetrated by the employee, regardless of whether the employer or covered entity knows or should have known of the conduct and fails to take immediate and appropriate corrective action.
(4)(A)For purposes of this subdivision only, employer means any person regularly employing one or more persons or regularly receiving the services of one or more persons providing services pursuant to a contract, or any person acting as an agent of an employer, directly or indirectly, the state, or any political or civil subdivision of the state, and cities. The definition of employer in subdivision (d) of Section 12926 applies to all provisions of this section other than this subdivision.
(B)Notwithstanding subparagraph (A), for purposes of this subdivision, employer does not include a religious association or corporation not organized for private profit, except as provided in Section 12926.2.
(C)For purposes of this subdivision, harassment because of sex includes sexual harassment, gender harassment, and harassment based on pregnancy, childbirth, or related medical conditions. Sexually harassing conduct need not be motivated by sexual desire.
(5)For purposes of this subdivision, a person providing services pursuant to a contract means a person who meets all of the following criteria:
(A)The person has the right to control the performance of the contract for services and discretion as to the manner of performance.
(B)The person is customarily engaged in an independently established business.
(C)The person has control over the time and place the work is performed, supplies the tools and instruments used in the work, and performs work that requires a particular skill not ordinarily used in the course of the employers work.
(k)For an employer, labor organization, employment agency, apprenticeship training program, or any training program leading to employment, to fail to take all reasonable steps necessary to prevent discrimination and harassment from occurring.
(l)(1)For an employer or other entity covered by this part to refuse to hire or employ a person or to refuse to select a person for a training program leading to employment or to bar or to discharge a person from employment or from a training program leading to employment, or to discriminate against a person in compensation or in terms, conditions, or privileges of employment because of a conflict between the persons religious belief or observance and any employment requirement, unless the employer or other entity covered by this part demonstrates that it has explored any available reasonable alternative means of accommodating the religious belief or observance, including the possibilities of excusing the person from those duties that conflict with the persons religious belief or observance or permitting those duties to be performed at another time or by another person, but is unable to reasonably accommodate the religious belief or observance without undue hardship, as defined in subdivision (u) of Section 12926, on the conduct of the business of the employer or other entity covered by this part. Religious belief or observance, as used in this section, includes, but is not limited to, observance of a Sabbath or other religious holy day or days, reasonable time necessary for travel prior and subsequent to a religious observance, and religious dress practice and religious grooming practice as described in subdivision (q) of Section 12926. This subdivision shall also apply to an apprenticeship training program, an unpaid internship, and any other program to provide unpaid experience for a person in the workplace or industry.
(2)An accommodation of an individuals religious dress practice or religious grooming practice is not reasonable if the accommodation requires segregation of the individual from other employees or the public.
(3)An accommodation is not required under this subdivision if it would result in a violation of this part or any other law prohibiting discrimination or protecting civil rights, including subdivision (b) of Section 51 of the Civil Code and Section 11135 of this code.
(4)For an employer or other entity covered by this part to, in addition to the employee protections provided pursuant to subdivision (h), retaliate or otherwise discriminate against a person for requesting accommodation under this subdivision, regardless of whether the request was granted.
(m)(1)For an employer or other entity covered by this part to fail to make reasonable accommodation for the known physical or mental disability of an applicant or employee. Nothing in this subdivision or in paragraph (1) or (2) of subdivision (a) shall be construed to require an accommodation that is demonstrated by the employer or other covered entity to produce undue hardship, as defined in subdivision (u) of Section 12926, to its operation.
(2)For an employer or other entity covered by this part to, in addition to the employee protections provided pursuant to subdivision (h), retaliate or otherwise discriminate against a person for requesting accommodation under this subdivision, regardless of whether the request was granted.
(n)For an employer or other entity covered by this part to fail to engage in a timely, good faith, interactive process with the employee or applicant to determine effective reasonable accommodations, if any, in response to a request for reasonable accommodation by an employee or applicant with a known physical or mental disability or known medical condition.
(o)For an employer or other entity covered by this part, to subject, directly or indirectly, any employee, applicant, or other person to a test for the presence of a genetic characteristic.
(p)For an employer to require, as a condition of employment, continued employment, or a benefit of employment, the disclosure of information relating to an applicants or employees reproductive health decisionmaking.
(p)(q)Nothing in this section shall be interpreted as preventing the ability of employers to identify members of the military or veterans for purposes of awarding a veterans preference as permitted by law.
SEC. 8.Section 12944 of the Government Code, as amended by Section 38 of Chapter 48 of the Statutes of 2022, is amended to read:12944.(a)It shall be unlawful for a licensing board to require any examination or establish any other qualification for licensing that has an adverse impact on any class by virtue of its race, creed, color, national origin or ancestry, sex, gender, gender identity, gender expression, age, medical condition, genetic information, physical disability, mental disability, reproductive health decisionmaking, or sexual orientation, unless the practice can be demonstrated to be job related.
Where the council, after hearing, determines that an examination is unlawful under this subdivision, the licensing board may continue to use and rely on the examination until such time as judicial review by the superior court of the determination is exhausted.
If an examination or other qualification for licensing is determined to be unlawful under this section, that determination shall not void, limit, repeal, or otherwise affect any right, privilege, status, or responsibility previously conferred upon any person by the examination or by a license issued in reliance on the examination or qualification.
(b)It shall be unlawful for a licensing board to fail or refuse to make reasonable accommodation to an individuals mental or physical disability or medical condition.
(c)It shall be unlawful for any licensing board, unless specifically acting in accordance with federal equal employment opportunity guidelines or regulations approved by the council, to print or circulate or cause to be printed or circulated any publication, or to make any non-job-related inquiry, either verbal or through use of an application form, which expresses, directly or indirectly, any limitation, specification, or discrimination as to race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, sex, gender, gender identity, gender expression, age, reproductive health decisionmaking, or sexual orientation or any intent to make any such limitation, specification, or discrimination. Nothing in this subdivision shall prohibit any licensing board from making, in connection with prospective licensure or certification, an inquiry as to, or a request for information regarding, the physical fitness of applicants if that inquiry or request for information is directly related and pertinent to the license or the licensed position the applicant is applying for. Nothing in this subdivision shall prohibit any licensing board, in connection with prospective examinations, licensure, or certification, from inviting individuals with physical or mental disabilities to request reasonable accommodations or from making inquiries related to reasonable accommodations.
(d)It is unlawful for a licensing board to discriminate against any person because the person has filed a complaint, testified, or assisted in any proceeding under this part.
(e)It is unlawful for any licensing board to fail to keep records of applications for licensing or certification for a period of two years following the date of receipt of the applications.
(f)As used in this section, licensing board means any state board, agency, or authority in the Business, Consumer Services, and Housing Agency that has the authority to grant licenses or certificates which are prerequisites to employment eligibility or professional status.
SEC. 9.Section 12993 of the Government Code is amended to read:12993.(a)The provisions of this part shall be construed liberally for the accomplishment of the purposes of this part. This part does not repeal any of the provisions of civil rights law or of any other law of this state relating to discrimination because of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, age, reproductive health decisionmaking, or sexual orientation, unless those provisions provide less protection to the enumerated classes of persons covered under this part.
(b)The provisions in in this part relating to discrimination in employment on account of sex or medical condition do not affect the operation of the terms or conditions of any bona fide retirement, pension, employee benefit, or insurance plan, provided the terms or conditions are in accordance with customary and reasonable or actuarially sound underwriting practices.
(c)While it is the intention of the Legislature to occupy the field of regulation of discrimination in employment and housing encompassed by the provisions of this part, exclusive of all other laws banning discrimination in employment and housing by any city, city and county, county, or other political subdivision of the state,this state, this part does not limit or restrict the application of Section 51 of the Civil Code.
SEC. 3.SEC. 10.Section 22853.3 is added to the Government Code, to read:22853.3.Commencing January 1, 2022, 2024, a health benefit plan or contract shall provide coverage for contraceptives and related services consistent with the requirements under Section 1367.25 of the Health and Safety Code and Section 10123.196 of the Insurance Code.
SEC. 4.SEC. 11.Section 22853.4 is added to the Government Code, to read:22853.4.Commencing January 1, 2022, 2024, a health benefit plan or contract shall provide coverage for vasectomies and related services consistent with the requirements under Section 1367.255 of the Health and Safety Code and Section 10123.1945 of the Insurance Code.
SEC. 5.SEC. 12.Section 1343 of the Health and Safety Code is amended to read:1343.(a)This chapter shall apply to health care service plans and specialized health care service plan contracts as defined in subdivisions (f) and (o) of Section 1345.
(b)The director may by the adoption of rules or the issuance of orders deemed necessary and appropriate, either unconditionally or upon specified terms and conditions or for specified periods, exempt from this chapter any class of persons or plan contracts if the director finds the action to be in the public interest and not detrimental to the protection of subscribers, enrollees, or persons regulated under this chapter, and that the regulation of the persons or plan contracts is not essential to the purposes of this chapter.
(c)The director, upon request of the Director of Health Care Services, shall exempt from this chapter any county-operated pilot program contracting with the State Department of Health Care Services pursuant to Article 7 (commencing with Section 14490) of Chapter 8 of Part 3 of Division 9 of the Welfare and Institutions Code. The director may exempt noncounty-operated pilot programs upon request of the Director of Health Care Services. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.
(d)Upon the request of the Director of Health Care Services, the director may exempt from this chapter any mental health plan contractor or any capitated rate contract under Chapter 8.9 (commencing with Section 14700) of Part 3 of Division 9 of the Welfare and Institutions Code. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.
(e)This chapter shall not apply to:
(1)A person organized and operating pursuant to a certificate issued by the Insurance Commissioner unless the entity is directly providing the health care service through those entity-owned or contracting health facilities and providers, in which case this chapter shall apply to the insurers plan and to the insurer.
(2)A plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, except that a plan described in this paragraph shall be subject to Section 1367.33.
(3)A person who does all of the following:
(A)Promises to provide care for life or for more than one year in return for a transfer of consideration from, or on behalf of, a person 60 years of age or older.
(B)Has obtained a written license pursuant to Chapter 2 (commencing with Section 1250) or Chapter 3.2 (commencing with Section 1569).
(C)Has obtained a certificate of authority from the State Department of Social Services.
(4)The Major Risk Medical Insurance Board when engaging in activities under Chapter 8 (commencing with Section 10700) of Part 2 of Division 2 of the Insurance Code, Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code, and Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code.
(5)The California Small Group Reinsurance Fund.
SEC. 6.Section 1367.25 of the Health and Safety Code is amended to read:1367.25.(a)A group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, and an individual health care service plan contract that is amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, except for a specialized health care service plan contract, shall provide coverage for the following, under general terms and conditions applicable to all benefits:(1)A health care service plan contract that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods designated by the plan. In the event the patients participating provider, acting within the providers scope of practice, determines that none of the methods designated by the plan is medically appropriate for the patients medical or personal history, the plan shall also provide coverage for another FDA-approved, medically appropriate prescription contraceptive method prescribed by the patients provider.(2)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.(b)(1)A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2022, shall provide coverage for all of the following services and contraceptive methods for all subscribers and enrollees:(A)Except as provided in subparagraphs (B) and (C) of paragraph (2), all FDA-approved contraceptive drugs, devices, and other products, including all FDA-approved contraceptive drugs, devices, and products available over the counter without a prescription, as follows:(i)A health care service plan shall not require a prescription to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.(ii)A health care service plan shall provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost sharing or medical management restrictions.(B)Voluntary tubal ligation, hysterectomy, and other similar sterilization procedures.(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device removal.(2)(A)Except for a grandfathered health care service plan, a health care service plan subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision. Cost sharing shall not be imposed on any Medi-Cal beneficiary.(B)If the FDA has approved one or more therapeutic equivalents, as that term is defined by the FDA, of a contraceptive drug, device, or product, a health care service plan is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, a health care service plan shall provide coverage without cost sharing for the original, brand name contraceptive.(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the enrollees provider, a health care service plan shall defer to the determination and judgment of the attending provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider. The department may promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an enrollee, an enrollees designee, or an enrollees provider to request coverage of an alternative prescribed contraceptive. A request for coverage under this subparagraph that is submitted by an enrollee, an enrollees designee, or prescribing provider shall be approved by the health care service plan in compliance with the time limits in Section 1367.241 and, as applicable, with the plans Medi-Cal managed care contract.(3)Except as otherwise authorized under this section, a health care service plan shall not infringe upon an enrollees choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.(4)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.(5)For purposes of this subdivision, health care service plan shall include Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.(c)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for FDA-approved contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.(1)For purposes of this section, a religious employer is an entity for which each of the following is true:(A)The inculcation of religious values is the purpose of the entity.(B)The entity primarily employs persons who share the religious tenets of the entity.(C)The entity serves primarily persons who share the religious tenets of the entity.(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.(2)Every religious employer that invokes the exemption provided under this subdivision shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive health care services the employer refuses to cover for religious reasons.(d)(1)Every health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2022, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an enrollee by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.(2)This subdivision shall not be construed to require a health care service plan contract to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the plans policies governing out-of-network coverage.(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.(4)A health care service plan subject to this subdivision shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies, to an amount that is less than a 12-month supply, and shall not require an enrollee to make any formal request for such coverage other than a pharmacy claim.(e)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee.(f)This section shall not be construed to deny or restrict the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.(g)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.(h)For purposes of this section, the following definitions apply:(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.(3)With respect to health care service plan contracts issued, amended, or renewed on or after January 1, 2016, provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of this code.(4)For purposes of this section, over-the-counter FDA-approved contraceptive drugs, devices, and products and over-the-counter birth control methods are limited to those included as essential health benefits pursuant to Section 1367.005.SEC. 13.Section 1367.25 of the Health and Safety Code is amended to read:1367.25.(a)A group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, and an individual health care service plan contract that is amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, except for a specialized health care service plan contract, shall provide coverage for the following, under general terms and conditions applicable to all benefits:
(1)A health care service plan contract that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods designated by the plan. In the event the patients participating provider, acting within his or her the providers scope of practice, determines that none of the methods designated by the plan is medically appropriate for the patients medical or personal history, the plan shall also provide coverage for another FDA-approved, medically appropriate prescription contraceptive method prescribed by the patients provider.
(2)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(b)(1)A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for women: all subscribers and enrollees:
(A)(i)Except as provided in clause (ii) and in subparagraphs (B) and (C) of paragraph (2), all FDA-approved contraceptive drugs, devices, and other products for women, products, including all FDA-approved contraceptive drugs, devices, and products available over the counter, as prescribed by the enrollees provider.
(ii)For any health care service plan contract described in paragraph (1) that is issued, amended, renewed, or delivered on or after January 1, 2024, both of the following conditions shall apply:
(I)A prescription shall not be required to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(II)Point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products shall be provided at in-network pharmacies without cost sharing or medical management restrictions.
(B)Voluntary tubal ligation and other similar sterilization procedures.
(C)Patient education and counseling on contraception.(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device insertion and removal.
(2)(A)Except for a grandfathered health plan, a health care service plan subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision. Cost sharing shall not be imposed on any Medi-Cal beneficiary.
(B)If the FDA has approved one or more therapeutic equivalents equivalents, as that term is defined by the FDA, of a contraceptive drug, device, or product, a health care service plan is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutic equivalent generic substitute available in the market, a health care service plan shall provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is not available, or is deemed medically inadvisable by the enrollees provider, a health care service plan shall provide coverage, subject to a plans utilization management procedures, for the prescribed contraceptive drug, device, or product without cost sharing. Any request by a contracting provider shall be responded to by the health care service plan in compliance with the Knox-Keene Health Care Service Plan Act of 1975, as set forth in this chapter defer to the determination and judgment of the provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives, and ability to adhere to the appropriate use of the drug or item, as determined by the provider. The department may promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an enrollee, an enrollees designee, or an enrollees provider to request coverage of an alternative prescribed contraceptive. A request for coverage under this subparagraph that is submitted by an enrollee, an enrollees designee, or provider shall be approved by the health care service plan in compliance with the time limits in Section 1367.241 and, as applicable, with the plans Medi-Cal managed care contract.
(3)Except as otherwise authorized under this section, a health care service plan shall not impose any restrictions or delays on the coverage required under this subdivision. infringe upon an enrollees choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(5)For purposes of paragraphs (2) and (3) of this subdivision, and subdivision (d), health care service plan shall include Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the benefits described in this subdivision are made the financial responsibility of the Medi-Cal managed care plan under its comprehensive risk contract with the State Department of Health Care Services. If some or all of the benefits described in this subdivision are not the financial responsibility of the Medi-Cal managed care plan, as determined by the State Department of Health Care Services, those benefits shall be available to Medi-Cal beneficiaries on a fee-for-service basis pursuant to subdivision (n) of Section 14132 of the Welfare and Institutions Code.
(c)(1)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for FDA-approved contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(1)(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive health care services the employer refuses to cover for religious reasons.(d)(1)Every health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an enrollee by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)Nothing in this This subdivision shall not be construed to require a health care service plan contract to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the plans policies governing out-of-network coverage.
(3)Nothing in this This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health care service plan subject to this subdivision, in the absence of clinical contraindications, shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply. supply, and shall not require an enrollee to make any formal request for such coverage other than a pharmacy claim.
(e)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within his or her the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee.
(f)This section shall not be construed to deny or restrict in any way the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(g)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(h)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to health care service plan contracts issued, amended, or renewed on or after January 1, 2016, provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of this code.
(4)For purposes of this section, over-the-counter FDA-approved contraceptive drugs, devices, and products and over-the-counter birth control methods are limited to those included as essential health benefits pursuant to Section 1367.005.
SEC. 7.SEC. 14.Section 1367.255 is added to the Health and Safety Code, immediately following Section 1367.25, to read:1367.255.(a)(1)A health care service plan contract issued, amended, renewed, or delivered on or after January 1, 2022, January 1, 2024, except for a grandfathered health plan or a qualifying health plan for a health savings account, shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy services and procedures. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost sharing for vasectomy services and procedures at the minimum level necessary to preserve the enrollees ability to claim tax-exempt contributions and withdrawals from the enrollees health savings account under Internal Revenue Service laws and regulations. laws, regulations, and guidance. Cost sharing shall not be imposed on a Medi-Cal beneficiary.
(2)A health care service plan shall not impose any restrictions or delays, including but not limited to including, but not limited to, prior authorization, on vasectomy services or procedures.
(3)Benefits for an enrollee under this section shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(4)For purposes of this section, health care service plan includes Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the benefits described in this subdivision are made the financial responsibility of the Medi-Cal managed care plan under its comprehensive risk contract with the State Department of Health Care Services. If some or all of the benefits described in this subdivision are not the financial responsibility of the Medi-Cal managed care plan, as determined by the State Department of Health Care Services, those benefits shall be available to Medi-Cal beneficiaries on a fee-for-service basis pursuant to subdivision (n) of Section 14132 of the Welfare and Institutions Code.
(b)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for vasectomy services and procedures. The exclusion from coverage under this provision shall not apply to a vasectomy service or procedure that is used vasectomy services or procedures for purposes other than contraception.
(1)A health care service plan that contracts with a religious employer to provide a health care service plan that does not include coverage and benefits for vasectomy services and procedures shall notify, in writing, upon initial enrollment and annually thereafter upon renewal, each enrollee that vasectomy services and procedures are not included in the enrollees health care service plan.
(1)(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive health services the employer refuses to cover for religious reasons.(c)This section shall not be construed to deny or restrict in any way the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(d)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(e)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
SEC. 8.SEC. 15.Section 1367.33 is added to the Health and Safety Code, to read:1367.33.Notwithstanding any other law, a plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, and that is approved issued, amended, renewed, or delivered, on or after January 1, 2023, 2024, shall comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255.
SEC. 9.SEC. 16.Section 10123.1945 is added to the Insurance Code, immediately following Section 10123.194, to read:10123.1945.(a)(1)A disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2022, January 1, 2024, except for a grandfathered health plan or a qualifying health plan for a health savings account, shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy services or procedures. For a qualifying health plan for a health savings account, an insurer shall establish the plans cost sharing for vasectomy services and procedures at the minimum level necessary to preserve the insureds ability to claim tax-exempt contributions and withdrawals from the insureds health savings account under Internal Revenue Service laws and regulations. laws, regulations, and guidance.
(2)An insurer shall not impose any restrictions or delays, including, but not limited to, prior authorization, on vasectomy services and procedures.
(3)Coverage with respect to an insured under this section shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)This section shall not be construed to deny or restrict in any way an existing right or benefit provided under law or by contract.
(c)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(d)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for vasectomy services and procedures. The exclusion from coverage under this provision shall not apply to a vasectomy service or procedure that is used vasectomy services or procedures for purposes other than contraception.
(1)An insurer that contracts with a religious employer to provide a disability insurance policy that does not include coverage and benefits for vasectomy services and procedures shall notify, in writing, upon initial enrollment and annually thereafter upon renewal, each enrollee that vasectomy services and procedures are not included in the insureds disability insurance policy.
(1)(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this subdivision shall provide written notice to prospective insureds, prior to obtaining coverage under the policy, listing the contraceptive health care services that the employer refuses to cover for religious reasons.(e)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(f)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
SEC. 10.Section 10123.196 of the Insurance Code is amended to read:10123.196.(a)An individual or group policy of disability insurance issued, amended, renewed, or delivered on or after January 1, 2000, through December 31, 2015, inclusive, that provides coverage for hospital, medical, or surgical expenses, shall provide coverage for the following, under the same terms and conditions as applicable to all benefits:(1)A disability insurance policy that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods, as designated by the insurer. If an insureds health care provider determines that none of the methods designated by the disability insurer is medically appropriate for the insureds medical or personal history, the insurer shall, in the alternative, provide coverage for some other FDA-approved prescription contraceptive method prescribed by the patients health care provider.(2)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.(b)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2022, shall provide coverage for all of the following services and contraceptive methods for all policyholders and insureds:(A)Except as provided in subparagraphs (B) and (C) of paragraph (2), all FDA-approved, contraceptive drugs, devices, and other products, including all FDA-approved, contraceptive drugs, devices, and products available over the counter without a prescription, as follows:(i)An insurer shall not require a prescription to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.(ii)An insurer shall provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing or medical management restrictions.(B)Voluntary tubal ligation, hysterectomy, and other similar sterilization procedures.(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device removal.(2)(A)Except for a grandfathered health plan, a disability insurer subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision.(B)If the FDA has approved one or more therapeutic equivalents, as that term is defined by the FDA, of a contraceptive drug, device, or product, a disability insurer is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, an insurer shall provide coverage without cost sharing for the original, brand name contraceptive.(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the insureds provider, a disability insurer shall defer to the determination and judgment of the attending provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider. The department may promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an insured, an insureds designee or an insureds provider to request coverage of an alternative prescribed contraceptive. A request for coverage under this subparagraph that is submitted by an insured, an insureds designee, or a prescribing provider shall be approved by the disability insurer in compliance with the time limits in Section 10123.191.(3)Except as otherwise authorized under this section, an insurer shall not infringe upon an insureds choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.(4)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.(c)This section shall not be construed to deny or restrict in any way any existing right or benefit provided under law or by contract.(d)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.(e)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.(1)For purposes of this section, a religious employer is an entity for which each of the following is true:(A)The inculcation of religious values is the purpose of the entity.(B)The entity primarily employs persons who share the religious tenets of the entity.(C)The entity serves primarily persons who share the religious tenets of the entity.(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.(2)Every religious employer that invokes the exemption provided under this subdivision shall provide written notice to prospective insureds prior to obtaining coverage under the policy, listing the contraceptive health care services the employer refuses to cover for religious reasons.(f)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2022, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an insured by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.(2)This subdivision shall not be construed to require a policy to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the insurers policies governing out-of-network coverage.(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.(4)An insurer subject to this subdivision shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply, and shall not require an insured to make any formal request for such coverage other than a pharmacy claim.(g)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an insured.(h)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.(i)For purposes of this section, the following definitions apply:(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.(3)With respect to policies of disability insurance issued, amended, or renewed on or after January 1, 2016, health care provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of the Health and Safety Code.(4)For purposes of this section, over-the-counter FDA-approved contraceptive drugs, devices, and products and over-the-counter birth control methods are limited to those included as essential health benefits pursuant to Section 10112.27.SEC. 17.Section 10123.196 of the Insurance Code is amended to read:10123.196.(a)An individual or group policy of disability insurance issued, amended, renewed, or delivered on or after January 1, 2000, through December 31, 2015, inclusive, that provides coverage for hospital, medical, or surgical expenses, shall provide coverage for the following, under the same terms and conditions as applicable to all benefits:
(1)A disability insurance policy that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods, as designated by the insurer. If an insureds health care provider determines that none of the methods designated by the disability insurer is medically appropriate for the insureds medical or personal history, the insurer shall, in the alternative, provide coverage for some other FDA-approved prescription contraceptive method prescribed by the patients health care provider.
(2)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for women: all policyholders and insureds:
(A)(i)Except as provided in clause (ii) and in subparagraphs (B) and (C) of paragraph (2), all FDA-approved, contraceptive drugs, devices, and other products for women, products, including all FDA-approved, contraceptive drugs, devices, and products available over the counter, as prescribed by the insureds provider.
(ii)For any policy described in paragraph (1) that is issued, amended, renewed, or delivered on or after January 1, 2024, both of the following conditions shall apply:
(I)A prescription shall not be required to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(II)Point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products shall be provided at in-network pharmacies without cost sharing or medical management restrictions.
(B)Voluntary tubal ligation and other similar sterilization procedures.
(C)Patient education and counseling on contraception.(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device insertion and removal.
(2)(A)Except for a grandfathered health plan, a disability insurer subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision.
(B)If the FDA has approved one or more therapeutic equivalents equivalents, as that term is defined by the FDA, of a contraceptive drug, device, or product, a disability insurer is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, an insurer shall provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is not available, or is deemed medically inadvisable by the insureds provider, a disability insurer shall provide coverage, subject to an insurers utilization management procedures, for the prescribed contraceptive drug, device, or product without cost sharing. Any request by a contracting provider shall be responded to by the disability insurer in compliance with defer to the determination and judgment of the provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives, and ability to adhere to the appropriate use of the drug or item, as determined by the provider. The department may promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an insured, an insureds designee, or an insureds provider to request coverage of an alternative prescribed contraceptive. A request for coverage under this subparagraph that is submitted by an insured, an insureds designee, or a provider shall be approved by the disability insurer in compliance with the time limits in Section 10123.191.
(3)Except as otherwise authorized under this section, an insurer shall not infringe upon an insureds choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision. subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(c)This section shall not be construed to deny or restrict in any way any existing right or benefit provided under law or by contract.
(d)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(e)(1)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(1)(2)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this section shall provide written notice to any prospective employee once an offer of employment has been made, and prior to that person commencing that employment, listing the contraceptive health care services the employer refuses to cover for religious reasons.(f)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an insured by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)Nothing in this This subdivision shall not be construed to require a policy to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the insurers policies governing out-of-network coverage.
(3)Nothing in this This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health An insurer subject to this subdivision, in the absence of clinical contraindications, subdivision shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply. supply, and shall not require an insured to make any formal request for such coverage other than a pharmacy claim.
(g)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within his or her the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an insured.
(h)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(i)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to policies of disability insurance issued, amended, or renewed on or after January 1, 2016, health care provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
(4)For purposes of this section, over-the-counter FDA-approved contraceptive drugs, devices, and products and over-the-counter birth control methods are limited to those included as essential health benefits pursuant to Section 10112.27.
SEC. 11.SEC. 18.Section 10127.20 is added to the Insurance Code, to read:10127.20.Notwithstanding any other law, a disability insurance policy that provides hospital, medical, surgical, prescription drug, or nursing benefits, except a policy providing only dental or vision benefits, that is approved issued, amended, renewed, or delivered, on or after January 1, 2022, 2024, and that is issued to a bona fide public or private institution of higher learning and provides coverage to its students and their dependents, or to its faculty, staff, administration, and their respective dependents, shall comply with the coverage requirements of Sections 10123.1945 and 10123.196.
SEC. 12.Section 2810.9 is added to the Labor Code, to read:2810.9.(a)An employer shall not fail or refuse to hire or discharge any individual or otherwise discriminate or take any retaliatory personnel action against any employee with respect to compensation, terms, conditions, or privileges of employment because of the employees or their dependents reproductive health decisionmaking, including a decision to use or access a particular drug, device, or medical service.(b)An employer, or any person acting on behalf of an employer, who takes any adverse employment action against an employee in violation of subdivision (a) is liable to the aggrieved employee, who shall recover a penalty pursuant to Section 98.6 and obtain any other appropriate relief to remedy the violation, including reinstatement, reimbursement of lost wages and interest thereon, and other compensation or equitable relief appropriate to the circumstances.(c)Any contract or agreement, express or implied, made by an employee to waive the benefits of this section is null and void.(d)An employer that requires compliance with an employee handbook shall include in the handbook notice of the employee rights and remedies under this section.(e)The rights and remedies conferred by this section are in addition to, and not in limitation of, any right or remedy lawfully granted under the California Fair Employment and Housing Act (Part 2.8 (commencing with Section 12900) of Division 3 of Title 2 of the Government Code).(f)This section does not create a new basis upon which an employee can accrue or use benefits relating to paid or protected time off.SEC. 13.SEC. 19.Section 10509.5 is added to the Public Contract Code, to read:10509.5.Notwithstanding any other law, commencing January 1, 2022, 2024, the University of California shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255 of the Health and Safety Code Sections 10123.1945 and 10123.196 of the Insurance Code.
SEC. 14.SEC. 20.Section 10828 is added to the Public Contract Code, to read:10828.Notwithstanding any other law, commencing January 1, 2022, 2024, the California State University shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255 of the Health and Safety Code Code, and Sections 10123.1945 and 10123.196 of the Insurance Code.
SEC. 21.Section 14132 of the Welfare and Institutions Code is amended to read:14132.The following is the schedule of benefits under this chapter:
(a)Outpatient services are covered as follows:
Physician, hospital or clinic outpatient, surgical center, respiratory care, optometric, chiropractic, psychology, podiatric, occupational therapy, physical therapy, speech therapy, audiology, acupuncture to the extent federal matching funds are provided for acupuncture, and services of persons rendering treatment by prayer or healing by spiritual means in the practice of any church or religious denomination insofar as these can be encompassed by federal participation under an approved plan, subject to utilization controls.
(b)(1)Inpatient hospital services, including, but not limited to, physician and podiatric services, physical therapy, and occupational therapy, are covered subject to utilization controls.
(2)For a Medi-Cal fee-for-service beneficiary, emergency services and care that are necessary for the treatment of an emergency medical condition and medical care directly related to the emergency medical condition. This paragraph does not change the obligation of Medi-Cal managed care plans to provide emergency services and care. For the purposes of this paragraph, emergency services and care and emergency medical condition have the same meanings as those terms are defined in Section 1317.1 of the Health and Safety Code.
(c)Nursing facility services, subacute care services, and services provided by any category of intermediate care facility for the developmentally disabled, including podiatry, physician, nurse practitioner services, and prescribed drugs, as described in subdivision (d), are covered subject to utilization controls. Respiratory care, physical therapy, occupational therapy, speech therapy, and audiology services for patients in nursing facilities and any category of intermediate care facility for persons with developmental disabilities are covered subject to utilization controls.
(d)(1)Purchase of prescribed drugs is covered subject to the Medi-Cal List of Contract Drugs and utilization controls.
(2)Purchase of drugs used to treat erectile dysfunction or any off-label uses of those drugs are covered only to the extent that federal financial participation is available.
(3)(A)To the extent required by federal law, the purchase of outpatient prescribed drugs, for which the prescription is executed by a prescriber in written, nonelectronic form on or after April 1, 2008, is covered only when executed on a tamper resistant prescription form. The implementation of this paragraph shall conform to the guidance issued by the federal Centers for Medicare and Medicaid Services, but shall not conflict with state statutes on the characteristics of tamper resistant prescriptions for controlled substances, including Section 11162.1 of the Health and Safety Code. The department shall provide providers and beneficiaries with as much flexibility in implementing these rules as allowed by the federal government. The department shall notify and consult with appropriate stakeholders in implementing, interpreting, or making specific this paragraph.
(B)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may take the actions specified in subparagraph (A) by means of a provider bulletin or notice, policy letter, or other similar instructions without taking regulatory action.
(4)(A)(i)For the purposes of this paragraph, nonlegend has the same meaning as defined in subdivision (a) of Section 14105.45.
(ii)Nonlegend acetaminophen-containing products, including childrens acetaminophen-containing products, selected by the department are covered benefits.
(iii)Nonlegend cough and cold products selected by the department are covered benefits.
(B)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may take the actions specified in subparagraph (A) by means of a provider bulletin or notice, policy letter, or other similar instruction without taking regulatory action.
(e)Outpatient dialysis services and home hemodialysis services, including physician services, medical supplies, drugs, and equipment required for dialysis, are covered, subject to utilization controls.
(f)Anesthesiologist services when provided as part of an outpatient medical procedure, nurse anesthetist services when rendered in an inpatient or outpatient setting under conditions set forth by the director, outpatient laboratory services, and x-ray services are covered, subject to utilization controls. This subdivision does not require prior authorization for anesthesiologist services provided as part of an outpatient medical procedure or for portable x-ray services in a nursing facility or any category of intermediate care facility for the developmentally disabled.
(g)Blood and blood derivatives are covered.
(h)(1)Emergency and essential diagnostic and restorative dental services, except for orthodontic, fixed bridgework, and partial dentures that are not necessary for balance of a complete artificial denture, are covered, subject to utilization controls. The utilization controls shall allow emergency and essential diagnostic and restorative dental services and prostheses that are necessary to prevent a significant disability or to replace previously furnished prostheses that are lost or destroyed due to circumstances beyond the beneficiarys control. Notwithstanding the foregoing, the director may by regulation provide for certain fixed artificial dentures necessary for obtaining employment or for medical conditions that preclude the use of removable dental prostheses, and for orthodontic services in cleft palate deformities administered by the departments California Childrens Services program.
(2)For persons 21 years of age or older, the services specified in paragraph (1) shall be provided subject to the following conditions:
(A)Periodontal treatment is not a benefit.
(B)Endodontic therapy is not a benefit except for vital pulpotomy.
(C)Laboratory processed crowns are not a benefit.
(D)Removable prosthetics shall be a benefit only for patients as a requirement for employment.
(E)The director may, by regulation, provide for the provision of fixed artificial dentures that are necessary for medical conditions that preclude the use of removable dental prostheses.
(F)Notwithstanding the conditions specified in subparagraphs (A) to (E), inclusive, the department may approve services for persons with special medical disorders subject to utilization review.
(3)Paragraph (2) shall become inoperative on July 1, 1995.
(i)Medical transportation is covered, subject to utilization controls.
(j)Home health care services are covered, subject to utilization controls.
(k)(1)Prosthetic and orthotic devices and eyeglasses are covered, subject to utilization controls. Utilization controls shall allow replacement of prosthetic and orthotic devices and eyeglasses necessary because of loss or destruction due to circumstances beyond the beneficiarys control. Frame styles for eyeglasses replaced pursuant to this subdivision shall not change more than once every two years, unless the department so directs.
(2)Orthopedic and conventional shoes are covered when provided by a prosthetic and orthotic supplier on the prescription of a physician and when at least one of the shoes will be attached to a prosthesis or brace, subject to utilization controls. Modification of stock conventional or orthopedic shoes when medically indicated is covered, subject to utilization controls. If there is a clearly established medical need that cannot be satisfied by the modification of stock conventional or orthopedic shoes, custom-made orthopedic shoes are covered, subject to utilization controls.
(3)Therapeutic shoes and inserts are covered when provided to a beneficiary with a diagnosis of diabetes, subject to utilization controls, to the extent that federal financial participation is available.
(l)Hearing aids are covered, subject to utilization controls. Utilization controls shall allow replacement of hearing aids necessary because of loss or destruction due to circumstances beyond the beneficiarys control.
(m)Durable medical equipment and medical supplies are covered, subject to utilization controls. The utilization controls shall allow the replacement of durable medical equipment and medical supplies when necessary because of loss or destruction due to circumstances beyond the beneficiarys control. The utilization controls shall allow authorization of durable medical equipment needed to assist a disabled beneficiary in caring for a child for whom the disabled beneficiary is a parent, stepparent, foster parent, or legal guardian, subject to the availability of federal financial participation. The department shall adopt emergency regulations to define and establish criteria for assistive durable medical equipment in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(n)Family planning services are covered, subject to utilization controls. However, for Medi-Cal managed care plans, utilization controls shall be subject to Section 1367.25 Sections 1367.25 and 1367.255 of the Health and Safety Code.
(o)Inpatient intensive rehabilitation hospital services, including respiratory rehabilitation services, in a general acute care hospital are covered, subject to utilization controls, when either of the following criteria are met:
(1)A patient with a permanent disability or severe impairment requires an inpatient intensive rehabilitation hospital program as described in Section 14064 to develop function beyond the limited amount that would occur in the normal course of recovery.
(2)A patient with a chronic or progressive disease requires an inpatient intensive rehabilitation hospital program as described in Section 14064 to maintain the patients present functional level as long as possible.
(p)(1)Adult day health care is covered in accordance with Chapter 8.7 (commencing with Section 14520).
(2)Commencing 30 days after the effective date of the act that added this paragraph, and notwithstanding the number of days previously approved through a treatment authorization request, adult day health care is covered for a maximum of three days per week.
(3)As provided in accordance with paragraph (4), adult day health care is covered for a maximum of five days per week.
(4)As of the date that the director makes the declaration described in subdivision (g) of Section 14525.1, paragraph (2) shall become inoperative and paragraph (3) shall become operative.
(q)(1)Application of fluoride, or other appropriate fluoride treatment as defined by the department, and other prophylaxis treatment for children 17 years of age and under are covered.
(2)All dental hygiene services provided by a registered dental hygienist, registered dental hygienist in extended functions, and registered dental hygienist in alternative practice licensed pursuant to Sections 1753, 1917, 1918, and 1922 of the Business and Professions Code may be covered as long as they are within the scope of Denti-Cal benefits and they are necessary services provided by a registered dental hygienist, registered dental hygienist in extended functions, or registered dental hygienist in alternative practice.
(r)(1)Paramedic services performed by a city, county, or special district, or pursuant to a contract with a city, county, or special district, and pursuant to a program established under former Article 3 (commencing with Section 1480) of Chapter 2.5 of Division 2 of the Health and Safety Code by a paramedic certified pursuant to that article, and consisting of defibrillation and those services specified in subdivision (3) of former Section 1482 of the article.
(2)A provider enrolled under this subdivision shall satisfy all applicable statutory and regulatory requirements for becoming a Medi-Cal provider.
(3)This subdivision shall be implemented only to the extent funding is available under Section 14106.6.
(s)(1)In-home medical care services are covered when medically appropriate and subject to utilization controls, for a beneficiary who would otherwise require care for an extended period of time in an acute care hospital at a cost higher than in-home medical care services. The director shall have the authority under this section to contract with organizations qualified to provide in-home medical care services to those persons. These services may be provided to a patient placed in a shared or congregate living arrangement, if a home setting is not medically appropriate or available to the beneficiary.
(2)As used in this subdivision, in-home medical care service includes utility bills directly attributable to continuous, 24-hour operation of life-sustaining medical equipment, to the extent that federal financial participation is available.
(3)As used in this subdivision, in-home medical care services include, but are not limited to:
(A)Level-of-care and cost-of-care evaluations.
(B)Expenses, directly attributable to home care activities, for materials.
(C)Physician fees for home visits.
(D)Expenses directly attributable to home care activities for shelter and modification to shelter.
(E)Expenses directly attributable to additional costs of special diets, including tube feeding.
(F)Medically related personal services.
(G)Home nursing education.
(H)Emergency maintenance repair.
(I)Home health agency personnel benefits that permit coverage of care during periods when regular personnel are on vacation or using sick leave.
(J)All services needed to maintain antiseptic conditions at stoma or shunt sites on the body.
(K)Emergency and nonemergency medical transportation.
(L)Medical supplies.
(M)Medical equipment, including, but not limited to, scales, gurneys, and equipment racks suitable for paralyzed patients.
(N)Utility use directly attributable to the requirements of home care activities that are in addition to normal utility use.
(O)Special drugs and medications.
(P)Home health agency supervision of visiting staff that is medically necessary, but not included in the home health agency rate.
(Q)Therapy services.
(R)Household appliances and household utensil costs directly attributable to home care activities.
(S)Modification of medical equipment for home use.
(T)Training and orientation for use of life-support systems, including, but not limited to, support of respiratory functions.
(U)Respiratory care practitioner services as defined in Sections 3702 and 3703 of the Business and Professions Code, subject to prescription by a physician and surgeon.
(4)A beneficiary receiving in-home medical care services is entitled to the full range of services within the Medi-Cal scope of benefits as defined by this section, subject to medical necessity and applicable utilization control. Services provided pursuant to this subdivision, which are not otherwise included in the Medi-Cal schedule of benefits, shall be available only to the extent that federal financial participation for these services is available in accordance with a home- and community-based services waiver.
(t)Home- and community-based services approved by the United States Department of Health and Human Services are covered to the extent that federal financial participation is available for those services under the state plan or waivers granted in accordance with Section 1315 or 1396n of Title 42 of the United States Code. The director may seek waivers for any or all home- and community-based services approvable under Section 1315 or 1396n of Title 42 of the United States Code. Coverage for those services shall be limited by the terms, conditions, and duration of the federal waivers.
(u)Comprehensive perinatal services, as provided through an agreement with a health care provider designated in Section 14134.5 and meeting the standards developed by the department pursuant to Section 14134.5, subject to utilization controls.
The department shall seek any federal waivers necessary to implement the provisions of this subdivision. The provisions for which appropriate federal waivers cannot be obtained shall not be implemented. Provisions for which waivers are obtained or for which waivers are not required shall be implemented notwithstanding any inability to obtain federal waivers for the other provisions. No provision of this subdivision shall be implemented unless matching funds from Subchapter XIX (commencing with Section 1396) of Chapter 7 of Title 42 of the United States Code are available.
(v)Early and periodic screening, diagnosis, and treatment for any individual under 21 years of age is covered, consistent with the requirements of Subchapter XIX (commencing with Section 1396) of Chapter 7 of Title 42 of the United States Code.
(w)Hospice service that is Medicare-certified hospice service is covered, subject to utilization controls. Coverage shall be available only to the extent that no additional net program costs are incurred.
(x)When a claim for treatment provided to a beneficiary includes both services that are authorized and reimbursable under this chapter and services that are not reimbursable under this chapter, that portion of the claim for the treatment and services authorized and reimbursable under this chapter shall be payable.
(y)Home- and community-based services approved by the United States Department of Health and Human Services for a beneficiary with a diagnosis of Acquired Immune Deficiency Syndrome (AIDS) or AIDS-related complex, who requires intermediate care or a higher level of care.
Services provided pursuant to a waiver obtained from the Secretary of the United States Department of Health and Human Services pursuant to this subdivision, and that are not otherwise included in the Medi-Cal schedule of benefits, shall be available only to the extent that federal financial participation for these services is available in accordance with the waiver, and subject to the terms, conditions, and duration of the waiver. These services shall be provided to a beneficiary in accordance with the clients needs as identified in the plan of care, and subject to medical necessity and applicable utilization control.
The director may, under this section, contract with organizations qualified to provide, directly or by subcontract, services provided for in this subdivision to an eligible beneficiary. Contracts or agreements entered into pursuant to this division shall not be subject to the Public Contract Code.
(z)Respiratory care when provided in organized health care systems as defined in Section 3701 of the Business and Professions Code, and as an in-home medical service as outlined in subdivision (s).
(aa)(1)There is hereby established in the department a program to provide comprehensive clinical family planning services to any person who has a family income at or below 200 percent of the federal poverty level, as revised annually, and who is eligible to receive these services pursuant to the waiver identified in paragraph (2). This program shall be known as the Family Planning, Access, Care, and Treatment (Family PACT) Program.
(2)The department shall seek a waiver in accordance with Section 1315 of Title 42 of the United States Code, or a state plan amendment adopted in accordance with Section 1396a(a)(10)(A)(ii)(XXI) of Title 42 of the United States Code, which was added to Section 1396a of Title 42 of the United States Code by Section 2303(a)(2) of the federal Patient Protection and Affordable Care Act (PPACA) (Public Law 111-148), for a program to provide comprehensive clinical family planning services as described in paragraph (8). Under the waiver, the program shall be operated only in accordance with the waiver and the statutes and regulations in paragraph (4) and subject to the terms, conditions, and duration of the waiver. Under the state plan amendment, which shall replace the waiver and shall be known as the Family PACT successor state plan amendment, the program shall be operated only in accordance with this subdivision and the statutes and regulations in paragraph (4). The state shall use the standards and processes imposed by the state on January 1, 2007, including the application of an eligibility discount factor to the extent required by the federal Centers for Medicare and Medicaid Services, for purposes of determining eligibility as permitted under Section 1396a(a)(10)(A)(ii)(XXI) of Title 42 of the United States Code. To the extent that federal financial participation is available, the program shall continue to conduct education, outreach, enrollment, service delivery, and evaluation services as specified under the waiver. The services shall be provided under the program only if the waiver and, when applicable, the successor state plan amendment are approved by the federal Centers for Medicare and Medicaid Services and only to the extent that federal financial participation is available for the services. This section does not prohibit the department from seeking the Family PACT successor state plan amendment during the operation of the waiver.
(3)Solely for the purposes of the waiver or Family PACT successor state plan amendment and notwithstanding any other law, the collection and use of an individuals social security number shall be necessary only to the extent required by federal law.
(4)Sections 14105.3 to 14105.39, inclusive, 14107.11, 24005, and 24013, and any regulations adopted under these statutes shall apply to the program provided for under this subdivision. No other law under the Medi-Cal program or the State-Only Family Planning Program shall apply to the program provided for under this subdivision.
(5)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, without taking regulatory action, the provisions of the waiver after its approval by the federal Centers for Medicare and Medicaid Services and the provisions of this section by means of an all-county letter or similar instruction to providers. Thereafter, the department shall adopt regulations to implement this section and the approved waiver in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. Beginning six months after the effective date of the act adding this subdivision, the department shall provide a status report to the Legislature on a semiannual basis until regulations have been adopted.
(6)If the Department of Finance determines that the program operated under the authority of the waiver described in paragraph (2) or the Family PACT successor state plan amendment is no longer cost effective, this subdivision shall become inoperative on the first day of the first month following the issuance of a 30-day notification of that determination in writing by the Department of Finance to the chairperson in each house that considers appropriations, the chairpersons of the committees, and the appropriate subcommittees in each house that considers the State Budget, and the Chairperson of the Joint Legislative Budget Committee.
(7)If this subdivision ceases to be operative, all persons who have received or are eligible to receive comprehensive clinical family planning services pursuant to the waiver described in paragraph (2) shall receive family planning services under the Medi-Cal program pursuant to subdivision (n) if they are otherwise eligible for Medi-Cal with no share of cost, or shall receive comprehensive clinical family planning services under the program established in Division 24 (commencing with Section 24000) either if they are eligible for Medi-Cal with a share of cost or if they are otherwise eligible under Section 24003.
(8)For purposes of this subdivision, comprehensive clinical family planning services means the process of establishing objectives for the number and spacing of children, and selecting the means by which those objectives may be achieved. These means include a broad range of acceptable and effective methods and services to limit or enhance fertility, including contraceptive methods, federal Food and Drug Administration-approved contraceptive drugs, devices, and supplies, natural family planning, abstinence methods, and basic, limited fertility management. Comprehensive clinical family planning services include, but are not limited to, preconception counseling, maternal and fetal health counseling, general reproductive health care, including diagnosis and treatment of infections and conditions, including cancer, that threaten reproductive capability, medical family planning treatment and procedures, including supplies and followup, and informational, counseling, and educational services. Comprehensive clinical family planning services shall not include abortion, pregnancy testing solely for the purposes of referral for abortion or services ancillary to abortions, or pregnancy care that is not incident to the diagnosis of pregnancy. Comprehensive clinical family planning services shall be subject to utilization control and include all of the following:
(A)Family planning related services and male and female sterilization. Family planning services for men and women shall include emergency services and services for complications directly related to the contraceptive method, federal Food and Drug Administration-approved contraceptive drugs, devices, and supplies, and followup, consultation, and referral services, as indicated, which may require treatment authorization requests.
(B)All United States Department of Agriculture, federal Food and Drug Administration-approved contraceptive drugs, devices, and supplies that are in keeping with current standards of practice and from which the individual may choose.
(C)Culturally and linguistically appropriate health education and counseling services, including informed consent, that include all of the following:
(i)Psychosocial and medical aspects of contraception.
(ii)Sexuality.
(iii)Fertility.
(iv)Pregnancy.
(v)Parenthood.
(vi)Infertility.
(vii)Reproductive health care.
(viii)Preconception and nutrition counseling.
(ix)Prevention and treatment of sexually transmitted infection.
(x)Use of contraceptive methods, federal Food and Drug Administration-approved contraceptive drugs, devices, and supplies.
(xi)Possible contraceptive consequences and followup.
(xii)Interpersonal communication and negotiation of relationships to assist individuals and couples in effective contraceptive method use and planning families.
(D)A comprehensive health history, updated at the next periodic visit (between 11 and 24 months after initial examination) that includes a complete obstetrical history, gynecological history, contraceptive history, personal medical history, health risk factors, and family health history, including genetic or hereditary conditions.
(E)A complete physical examination on initial and subsequent periodic visits.
(F)Services, drugs, devices, and supplies deemed by the federal Centers for Medicare and Medicaid Services to be appropriate for inclusion in the program.
(G)(i)Home test kits for sexually transmitted diseases, including any laboratory costs of processing the kit, that are deemed medically necessary or appropriate and ordered directly by an enrolled Medi-Cal or Family PACT clinician or furnished through a standing order for patient use based on clinical guidelines and individual patient health needs.
(ii)For purposes of this subparagraph, home test kit means a product used for a test recommended by the federal Centers for Disease Control and Prevention guidelines or the United States Preventive Services Task Force that has been CLIA-waived, FDA-cleared or -approved, or developed by a laboratory in accordance with established regulations and quality standards, to allow individuals to self-collect specimens for STDs, including HIV, remotely at a location outside of a clinical setting.
(iii)Reimbursement under this subparagraph shall be contingent upon the addition of codes specific to home test kits in the Current Procedural Terminology or Healthcare Common Procedure Coding System to comply with Health Insurance Portability and Accountability Act requirements. The home test kit shall be sent by the enrolled Family PACT provider to a Medi-Cal-enrolled laboratory with fee based on Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule.
(9)In order to maximize the availability of federal financial participation under this subdivision, the director shall have the discretion to implement the Family PACT successor state plan amendment retroactively to July 1, 2010.
(ab)(1)Purchase of prescribed enteral nutrition products is covered, subject to the Medi-Cal list of enteral nutrition products and utilization controls.
(2)Purchase of enteral nutrition products is limited to those products to be administered through a feeding tube, including, but not limited to, a gastric, nasogastric, or jejunostomy tube. A beneficiary under the Early and Periodic Screening, Diagnostic, and Treatment Program shall be exempt from this paragraph.
(3)Notwithstanding paragraph (2), the department may deem an enteral nutrition product, not administered through a feeding tube, including, but not limited to, a gastric, nasogastric, or jejunostomy tube, a benefit for patients with diagnoses, including, but not limited to, malabsorption and inborn errors of metabolism, if the product has been shown to be neither investigational nor experimental when used as part of a therapeutic regimen to prevent serious disability or death.
(4)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement the amendments to this subdivision made by the act that added this paragraph by means of all-county letters, provider bulletins, or similar instructions, without taking regulatory action.
(5)The amendments made to this subdivision by the act that added this paragraph shall be implemented June 1, 2011, or on the first day of the first calendar month following 60 days after the date the department secures all necessary federal approvals to implement this section, whichever is later.
(ac)Diabetic testing supplies are covered when provided by a pharmacy, subject to utilization controls.
(ad)(1)Nonmedical transportation is covered, subject to utilization controls and permissible time and distance standards, for a beneficiary to obtain covered Medi-Cal services.
(2)(A)(i)Nonmedical transportation includes, at a minimum, round trip transportation for a beneficiary to obtain covered Medi-Cal services by passenger car, taxicab, or any other form of public or private conveyance, and mileage reimbursement when conveyance is in a private vehicle arranged by the beneficiary and not through a transportation broker, bus passes, taxi vouchers, or train tickets.
(ii)Nonmedical transportation does not include the transportation of a sick, injured, invalid, convalescent, infirm, or otherwise incapacitated beneficiary by ambulance, litter van, or wheelchair van licensed, operated, and equipped in accordance with state and local statutes, ordinances, or regulations.
(B)Nonmedical transportation shall be provided for a beneficiary who can attest in a manner to be specified by the department that other currently available resources have been reasonably exhausted. For a beneficiary enrolled in a managed care plan, nonmedical transportation shall be provided by the beneficiarys managed care plan. For a Medi-Cal fee-for-service beneficiary, the department shall provide nonmedical transportation when those services are not available to the beneficiary under Sections 14132.44 and 14132.47.
(3)Nonmedical transportation shall be provided in a form and manner that is accessible, in terms of physical and geographic accessibility, for the beneficiary and consistent with applicable state and federal disability rights laws.
(4)It is the intent of the Legislature in enacting this subdivision to affirm the requirement under Section 431.53 of Title 42 of the Code of Federal Regulations, in which the department is required to provide necessary transportation, including nonmedical transportation, for recipients to and from covered services. This subdivision shall not be interpreted to add a new benefit to the Medi-Cal program.
(5)The department shall seek any federal approvals that may be required to implement this subdivision, including, but not limited to, approval of revisions to the existing state plan that the department determines are necessary to implement this subdivision.
(6)This subdivision shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized and any necessary federal approvals have been obtained.
(7)Prior to the effective date of any necessary federal approvals, nonmedical transportation was not a Medi-Cal managed care benefit with the exception of when provided as an Early and Periodic Screening, Diagnostic, and Treatment service.
(8)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this subdivision by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted. By July 1, 2018, the department shall adopt regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. Commencing January 1, 2018, and notwithstanding Section 10231.5 of the Government Code, the department shall provide a status report to the Legislature on a semiannual basis, in compliance with Section 9795 of the Government Code, until regulations have been adopted.
(9)This subdivision shall not be implemented until July 1, 2017.
(ae)(1)No sooner than January 1, 2022, Rapid Whole Genome Sequencing, including individual sequencing, trio sequencing for a parent or parents and their baby, and ultra-rapid sequencing, is a covered benefit for any Medi-Cal beneficiary who is one year of age or younger and is receiving inpatient hospital services in an intensive care unit.
(2)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this subdivision by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted.
(3)This subdivision shall be implemented only to the extent that any necessary federal approvals are obtained, and federal financial participation is available and not otherwise jeopardized.
(af)(1)Home test kits for sexually transmitted diseases that are deemed medically necessary or appropriate and ordered directly by an enrolled Medi-Cal clinician or furnished through a standing order for patient use based on clinical guidelines and individual patient health needs.
(2)For purposes of this subdivision, home test kit means a product used for a test recommended by the federal Centers for Disease Control and Prevention guidelines or the United States Preventive Services Task Force that has been CLIA-waived, FDA-cleared or -approved, or developed by a laboratory in accordance with established regulations and quality standards, to allow individuals to self-collect specimens for STDs, including HIV, remotely at a location outside of a clinical setting.
(3)Reimbursement under this subparagraph shall be contingent upon the addition of codes specific to home test kits in the Current Procedural Terminology or Healthcare Common Procedure Coding System to comply with Health Insurance Portability and Accountability Act requirements. The home test kit shall be sent by the enrolled Medi-Cal provider to a Medi-Cal-enrolled laboratory with fee based on Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule.
(4)This subdivision shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.
(5)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the State Department of Health Care Services may implement this subdivision by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, without taking any further regulatory action.
SEC. 15.SEC. 22.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
This act shall be known, and may be cited, as the Contraceptive Equity Act of 2021.
SEC. 2.The Legislature finds and declares all of the following:
(a)California has a long history of expanding timely access to birth control to prevent unintended pregnancy. Thanks to a combination of innovative policies and programs enacted statewide, unintended pregnancy rates are at a 30-year low.
(b)Despite the progress made, health disparities in reproductive health outcomes persist among Black, Indigenous and People of Color, including disproportionate unintended pregnancy, infant and maternal mortality, and (STD) sexually transmitted infection rates. The legislature Legislature must take action to ensure that all Californians have equitable access to preventive contraceptive care.
(c)The federal Patient Protection and Affordable Care Act (Public Law 111-148) included a mandate that most health insurance plans cover contraception without out-of-pocket costs for patients.
(d)Californias Contraceptive Coverage Equity Act of 2014 and the Annual Supply of Contraceptives Act of 2016, built on this federal policy and existing state law to be the first state in the country to require coverage of birth control methods approved by the federal Food and Drug Administration for women without cost-sharing cost sharing or restrictions and a 12-month supply of self-administered birth control dispensed at one time for individuals enrolled in health insurance plans and policies regulated by the Keene Health Care Service Act of 1975. Knox-Keene Health Care Service Plan Act of 1975.
(e)Since 2014, several other states have expanded on Californias model legislation to create more equitable contraceptive coverage and access by requiring most health insurance plans and policies to cover voluntary sterilization services and all birth control methods available over-the-counter without a prescription for all beneficiaries, regardless of gender.
(f)A report by the Guttmacher Institute shows that vasectomy is among the most effective and cost-effective contraceptive methods available.
(g)Trump-era attacks on birth control access have underscored the need to codify the expansion of contraceptive coverage for as many Californians as possible under state law.
(h)The COVID-19 public health emergency has also further illuminated the structural inequities that disproportionately affect youth, low-income people and communities of color in accessing birth control services. A report by the Guttmacher Institute revealed that 29 percent of White women, 38 percent of Black women and 45 percent of Latinas now face difficulties accessing birth control as a result of the pandemic.
(i)The Legislature intends to reduce sexual and reproductive health disparities and ensure greater health equity by providing a pathway for more Californians to get the contraceptive care they want, when they need it without inequitable delays or cost barriers.
(j)The Legislature intends for the relevant California departments and agencies to work in concert to ensure compliance with these provisions.
SEC. 3.Section 22856 is added to the Government Code, to read:22856.Notwithstanding any other law, commencing January 1, 2022, the board shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255 of the Health and Safety Code, Sections 10123.1945 and 10123.196 of the Insurance Code, and Senate Bill No. 999 (Ch. 499, Stats. 2016).SEC. 3.Section 22853.3 is added to the Government Code, to read:22853.3.Commencing January 1, 2022, a health benefit plan or contract shall provide coverage for contraceptives and related services consistent with the requirements under Section 1367.25 of the Health and Safety Code and Section 10123.196 of the Insurance Code.
SEC. 4.Section 22853.4 is added to the Government Code, to read:22853.4.Commencing January 1, 2022, a health benefit plan or contract shall provide coverage for vasectomies and related services consistent with the requirements under Section 1367.255 of the Health and Safety Code and Section 10123.1945 of the Insurance Code.
SEC. 4.SEC. 5.Section 1343 of the Health and Safety Code is amended to read:1343.(a)This chapter shall apply to health care service plans and specialized health care service plan contracts as defined in subdivisions (f) and (o) of Section 1345.
(b)The director may by the adoption of rules or the issuance of orders deemed necessary and appropriate, either unconditionally or upon specified terms and conditions or for specified periods, exempt from this chapter any class of persons or plan contracts if the director finds the action to be in the public interest and not detrimental to the protection of subscribers, enrollees, or persons regulated under this chapter, and that the regulation of the persons or plan contracts is not essential to the purposes of this chapter.
(c)The director, upon request of the Director of Health Care Services, shall exempt from this chapter any county-operated pilot program contracting with the State Department of Health Care Services pursuant to Article 7 (commencing with Section 14490) of Chapter 8 of Part 3 of Division 9 of the Welfare and Institutions Code. The director may exempt noncounty-operated pilot programs upon request of the Director of Health Care Services. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.
(d)Upon the request of the Director of Health Care Services, the director may exempt from this chapter any mental health plan contractor or any capitated rate contract under Chapter 8.9 (commencing with Section 14700) of Part 3 of Division 9 of the Welfare and Institutions Code. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.
(e)This chapter shall not apply to:
(1)A person organized and operating pursuant to a certificate issued by the Insurance Commissioner unless the entity is directly providing the health care service through those entity-owned or contracting health facilities and providers, in which case this chapter shall apply to the insurers plan and to the insurer.
(2)A plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, except that a plan described in this paragraph shall be subject to Section 1367.33 and Senate Bill No. 999 (Ch. 499, Stats. of 2016). 1367.33.
(3)A person who does all of the following:
(A)Promises to provide care for life or for more than one year in return for a transfer of consideration from, or on behalf of, a person 60 years of age or older.
(B)Has obtained a written license pursuant to Chapter 2 (commencing with Section 1250) or Chapter 3.2 (commencing with Section 1569).
(C)Has obtained a certificate of authority from the State Department of Social Services.
(4)The Major Risk Medical Insurance Board when engaging in activities under Chapter 8 (commencing with Section 10700) of Part 2 of Division 2 of the Insurance Code, Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code, and Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code.
(5)The California Small Group Reinsurance Fund.
SEC. 5.SEC. 6.Section 1367.25 of the Health and Safety Code is amended to read:1367.25.(a)A group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, and an individual health care service plan contract that is amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, except for a specialized health care service plan contract, shall provide coverage for the following, under general terms and conditions applicable to all benefits:
(1)A health care service plan contract that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods designated by the plan. In the event the patients participating provider, acting within the providers scope of practice, determines that none of the methods designated by the plan is medically appropriate for the patients medical or personal history, the plan shall also provide coverage for another FDA-approved, medically appropriate prescription contraceptive method prescribed by the patients provider.
(2)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(b)(1)A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2016, 2022, shall provide coverage for all of the following services and contraceptive methods for all subscribers and enrollees:
(A)Except as provided in subparagraphs (B) and (C) of paragraph (2), all FDA-approved contraceptive drugs, devices, and other products, including all FDA-approved contraceptive drugs, devices, and products available over the counter without a prescription, as follows:
(i)A health care service plan shall not require a prescription to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(ii)A health care service plan is required to shall provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing cost sharing or medical management restrictions.
(B)Voluntary tubal ligation ligation, hysterectomy, and other similar sterilization procedures.
(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device removal.
(2)(A)Except for a grandfathered health care service plan, a health care service plan subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision. Cost sharing shall not be imposed on any Medi-Cal beneficiary.
(B)If the FDA has approved one or more therapeutic equivalents equivalents, as that term is defined by the FDA, of a contraceptive drug, device, or product, a health care service plan is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, a health care service plan is required to shall provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the enrollees provider, a health care service plan shall defer to the determination and judgment of the attending provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider. The department may promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an enrollee, an enrollees designee, or an enrollees provider to request coverage of an alternative prescribed contraceptive. A request by a contracting provider shall be responded to by the health care service plan in compliance with the Knox-Keene Health Care Service Plan Act of 1975, as set forth in this chapter for coverage under this subparagraph that is submitted by an enrollee, an enrollees designee, or prescribing provider shall be approved by the health care service plan in compliance with the time limits in Section 1367.241 and, as applicable, with the plans Medi-Cal managed care contract.
(3)Except as otherwise authorized under this section, a health care service plan shall not infringe upon an enrollees choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(5)For purposes of this subdivision, health care service plan shall include Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
(c)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for FDA-approved contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(1)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this subdivision shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive health care services the employer refuses to cover for religious reasons.
(d)(1)Every health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2017, 2022, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an enrollee by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)This subdivision shall not be construed to require a health care service plan contract to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the plans policies governing out-of-network coverage.
(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health care service plan subject to this subdivision, in the absence of clinical contraindications, subdivision shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies supplies, to an amount that is less than a 12-month supply, and shall not require an enrollee to make any formal request for such coverage other than a pharmacy claim.
(e)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee.
(f)This section shall not be construed to deny or restrict the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(g)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(h)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to health care service plan contracts issued, amended, or renewed on or after January 1, 2016, provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of this code.
(4)For purposes of this section, over-the-counter FDA-approved contraceptive drugs, devices, and products and over-the-counter birth control methods are limited to those included as essential health benefits pursuant to Section 1367.005.
(i)The changes made to this section by the act that added this subdivision apply only to a health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2022.SEC. 6.SEC. 7.Section 1367.255 is added to the Health and Safety Code, immediately following section Section 1367.25, to read:1367.255.(a)(1)A health care service plan contract issued, amended, renewed, or delivered on or after January 1, 2022, except for a grandfathered health plan or a qualifying health plan for a health savings account, shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy coverage provided under the essential health benefits pursuant to Section 1367.005. services and procedures. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost-sharing for thecoverage required pursuant to this section and Section 1367.005 cost sharing for vasectomy services and procedures at the minimum level necessary to preserve the enrollees ability to claim tax-exempt contributions and withdrawals from the enrollees health savings account under Internal Revenue Service laws and regulations. Cost sharing shall not be imposed on a Medi-Cal beneficiary.
(2)A health care service plan shall not impose any restrictions or delays on the coverage required under this subdivision. delays, including but not limited to prior authorization, on vasectomy services or procedures.
(3)Benefits for an enrollee under this section shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(4)For purposes of this section, health care service plan includes Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
(b)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for vasectomy services and procedures. The exclusion from coverage under this provision shall not apply to a vasectomy service or procedure that is used for purposes other than contraception.
(1)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing vasectomy as a service or procedure that the contraceptive health services the employer refuses to cover for religious reasons.
(c)This section shall not be construed to deny or restrict in any way the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(d)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(e)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)Provider means an individual who is certified or licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of the Health and Safety Code.SEC. 7.SEC. 8.Section 1367.33 is added to the Health and Safety Code, to read:1367.33.Notwithstanding any other law, a plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, and that is approved on or after January 1, 2023, shall comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255 and Senate Bill No. 999 (Ch. 499, Stats. 2016). 1367.255.
SEC. 8.SEC. 9.Section 10123.1945 is added to the Insurance Code, immediately following Section 10123.194, to read:10123.1945.(a)(1)A disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2022, except for a grandfathered health plan or a qualifying health plan for a health savings account, shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy coverage provided under the essential health benefits pursuant to Section 10112.27. services or procedures. For a qualifying health plan for a health savings account, the carrier an insurer shall establish the plans cost-sharing for the coverage required pursuant to this section and Section 10112.27 cost sharing for vasectomy services and procedures at the minimum level necessary to preserve the insureds ability to claim tax-exempt contributions and withdrawals from the insureds health savings account under Internal Revenue Service laws and regulations.
(2)An insurer shall not impose any restrictions or delays on the coverage required under this subdivision. delays, including, but not limited to, prior authorization, on vasectomy services and procedures.
(3)Coverage with respect to an insured under this section shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)This section shall not be construed to deny or restrict in any way an existing right or benefit provided under law or by contract.
(c)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(d)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for vasectomy services and procedures. The exclusion from coverage under this provision shall not apply to a vasectomy service or procedure that is used for purposes other than contraception.
(1)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this section subdivision shall provide written notice to a prospective employee once an offer of employment has been made, and prior to that person commencing that employment, listing vasectomy as a service or procedure prospective insureds, prior to obtaining coverage under the policy, listing the contraceptive health care services that the employer refuses to cover for religious reasons.
(e)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(f)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)Health care provider means an individual who is certified or licensed practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of the Health and Safety Code.SEC. 9.SEC. 10.Section 10123.196 of the Insurance Code is amended to read:10123.196.(a)An individual or group policy of disability insurance issued, amended, renewed, or delivered on or after January 1, 2000, through December 31, 2015, inclusive, that provides coverage for hospital, medical, or surgical expenses, shall provide coverage for the following, under the same terms and conditions as applicable to all benefits:
(1)A disability insurance policy that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods, as designated by the insurer. If an insureds health care provider determines that none of the methods designated by the disability insurer is medically appropriate for the insureds medical or personal history, the insurer shall, in the alternative, provide coverage for some other FDA-approved prescription contraceptive method prescribed by the patients health care provider.
(2)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2016, 2022, shall provide coverage for all of the following services and contraceptive methods for all policyholders and insureds:
(A)Except as provided in subparagraphs (B) and (C) of paragraph (2), all FDA-approved, contraceptive drugs, devices, and other products, including all FDA-approved, contraceptive drugs, devices, and products available over the counter without a prescription, as follows:
(i)A health An insurer shall not require a prescription to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(ii)A health insurer is required to An insurer shall provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing or medical management restrictions.
(B)Voluntary tubal ligation ligation, hysterectomy, and other similar sterilization procedures.
(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device removal.
(2)(A)Except for a grandfathered health plan, a disability insurer subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision.
(B)If the FDA has approved one or more therapeutic equivalents equivalents, as that term is defined by the FDA, of a contraceptive drug, device, or product, a disability insurer is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, a health care service plan is required to an insurer shall provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the insureds provider, a disability insurer shall defer to the determination and judgment of the attending provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider. The department may promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an insured, an insureds designee or an insureds provider to request coverage of an alternative prescribed contraceptive. A request by a contracting provider shall be responded to by the disability insurer in compliance with for coverage under this subparagraph that is submitted by an insured, an insureds designee, or a prescribing provider shall be approved by the disability insurer in compliance with the time limits in Section 10123.191.
(3)Except as otherwise authorized under this section, an insurer shall not infringe upon an insureds choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(c)This section shall not be construed to deny or restrict in any way any existing right or benefit provided under law or by contract.
(d)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(e)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(1)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this subdivision shall provide written notice to prospective insureds prior to obtaining coverage under the policy, listing the contraceptive health care services the employer refuses to cover for religious reasons.
(f)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2017, 2022, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an insured by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)This subdivision shall not be construed to require a policy to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the insurers policies governing out-of-network coverage.
(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health An insurer subject to this subdivision, in the absence of clinical contraindications, subdivision shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply, and shall not require an insured to make any formal request for such coverage other than a pharmacy claim.
(g)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an insured.
(h)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(i)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to policies of disability insurance issued, amended, or renewed on or after January 1, 2016, health care provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
(4)For purposes of this section, over-the-counter FDA-approved contraceptive drugs, devices, and products and over-the-counter birth control methods are limited to those included as essential health benefits pursuant to Section 10112.27.
(j)The changes made to this section by the act that added this subdivision apply only to a health insurance policy that is issued, amended, renewed, or delivered on or after January 1, 2022.SEC. 10.SEC. 11.Section 10127.20 is added to the Insurance Code, to read:10127.20.Notwithstanding any other law, a policy directly issued by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, that is approved on or after January 1, 2023, shall comply with the contraceptive coverage requirements of Sections 10123.1945 and 10123.196, and Senate Bill No. 999 (Ch. 499, Stats. 2016). disability insurance policy that provides hospital, medical, surgical, prescription drug, or nursing benefits, except a policy providing only dental or vision benefits, that is approved on or after January 1, 2022, and that is issued to a bona fide public or private institution of higher learning and provides coverage to its students and their dependents, or to its faculty, staff, administration, and their respective dependents, shall comply with the coverage requirements of Sections 10123.1945 and 10123.196.
SEC. 11.SEC. 12.Section 2810.9 is added to the Labor Code, to read:2810.9.(a)An employer shall not fail or refuse to hire or discharge any individual or otherwise discriminate or take any retaliatory personnel action against any employee with respect to compensation, terms, conditions, or privileges of employment because of the employees or their dependents reproductive health decisionmaking, including a decision to use or access a particular drug, device, or medical service.
(b)An employer, or any person acting on behalf of an employer, who takes any adverse employment action against an employee in violation of subdivision (a) is liable to the aggrieved employee, who shall recover a penalty pursuant to Section 98.6 and obtain any other appropriate relief to remedy the violation, including reinstatement, reimbursement of lost wages and interest thereon, and other compensation or equitable relief appropriate to the circumstances.
(c)Any contract or agreement, express or implied, made by an employee to waive the benefits of this section is null and void.
(d)An employer that requires compliance with an employee handbook shall include in the handbook notice of the employee rights and remedies under this section.
(e)The rights and remedies conferred by this section are in addition to, and not in limitation of, any right or remedy lawfully granted under the California Fair Employment and Housing Act (Part 2.8 (commencing with Section 12900) of Division 3 of Title 2 of the Government Code).
(f)This section does not create a new basis upon which an employee can accrue or use benefits relating to paid or protected time off.
SEC. 12.SEC. 13.Section 10509.5 is added to the Public Contract Code, to read:10509.5.Notwithstanding any other law, commencing January 1, 2022, the University of California shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255 of the Health and Safety Code, Code Sections 10123.1945 and 10123.196 of the Insurance Code, and Senate Bill No. 999 (Ch. 499, Stats. 2016). Code.
SEC. 13.SEC. 14.Section 10828 is added to the Public Contract Code, to read:10828.Notwithstanding any other law, commencing January 1, 2022, the California State University shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Sections 1367.25 and 1367.255 of the Health and Safety Code, Code Sections 10123.1945 and 10123.196 of the Insurance Code, and Senate Bill No. 999 (Ch. 499, Stats. 2016). Code.
SEC. 14.SEC. 15.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
This act shall be known, and may be cited, as the Contraceptive Equity Act of 2021.
SEC. 2.The Legislature finds and declares all of the following:
(a)California has a long history of expanding timely access to birth control to prevent unintended pregnancy. Thanks to a combination of innovative policies and programs enacted statewide, unintended pregnancy rates are at a 30-year low.
(b)Despite the progress made, health disparities in reproductive health outcomes persist among Black, Indigenous and People of Color, including disproportionate unintended pregnancy, infant and maternal mortality, and (STD) rates. The legislature must take action to ensure that all Californians have equitable access to preventive contraceptive care.
(c)The federal Patient Protection and Affordable Care Act (Public Law 111-148) included a mandate that most health insurance plans cover contraception without out-of-pocket costs for patients.
(d)Californias Contraceptive Coverage Equity Act of 2014 and the Annual Supply of Contraceptives Act of 2016, built on this federal policy and existing state law to be the first state in the country to require coverage of birth control methods approved by the federal Food and Drug Administration for women without cost-sharing or restrictions and a 12-month supply of self-administered birth control dispensed at one time for individuals enrolled in health insurance plans and policies regulated by the Keene Health Care Service Act of 1975.
(e)Since 2014, several other states have expanded on Californias model legislation to create more equitable contraceptive coverage and access by requiring most health insurance plans and policies to cover voluntary sterilization services and all birth control methods available over-the-counter without a prescription for all beneficiaries, regardless of gender.
(f)A report by the Guttmacher Institute shows that vasectomy is among the most effective and cost-effective contraceptive methods available.
(g)Trump-era attacks on birth control access have underscored the need to codify the expansion of contraceptive coverage for as many Californians as possible under state law.
(h)The COVID-19 public health emergency has also further illuminated the structural inequities that disproportionately affect youth, low-income people and communities of color in accessing birth control services. A report by the Guttmacher Institute revealed that 29 percent of White women, 38 percent of Black women and 45 percent of Latinas now face difficulties accessing birth control as a result of the pandemic.
(i)The COVID-19 pandemic has exacerbated rates of sexually transmitted diseases STDs in California and across the country that were already skyrocketing to epidemic proportions prior to the public health emergency. Condoms are the only birth control method that also reduce STD transmission rates.(j)(i)The Legislature intends to reduce sexual and reproductive health disparities and ensure greater health equity by providing a pathway for more Californians to get the contraceptive care they want, when they need it without inequitable delays or cost barriers.
(k)(j)The Legislature intends for the relevant California departments and agencies to work in concert to ensure compliance with these provisions.
SEC. 3.Section 22856 is added to the Government Code, to read:22856.Notwithstanding any other law, commencing January 1, 2022, the board shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Section 1367.25 of the Health and Safety Code, Section 10123.196 Sections 1367.25 and 1367.255 of the Health and Safety Code, Sections 10123.1945 and 10123.196 of the Insurance Code, and Senate Bill No. 999 (Ch. 499, Stats. 2016).
SEC. 4.Section 1343 of the Health and Safety Code is amended to read:1343.(a)This chapter shall apply to health care service plans and specialized health care service plan contracts as defined in subdivisions (f) and (o) of Section 1345.
(b)The director may by the adoption of rules or the issuance of orders deemed necessary and appropriate, either unconditionally or upon specified terms and conditions or for specified periods, exempt from this chapter any class of persons or plan contracts if the director finds the action to be in the public interest and not detrimental to the protection of subscribers, enrollees, or persons regulated under this chapter, and that the regulation of the persons or plan contracts is not essential to the purposes of this chapter.
(c)The director, upon request of the Director of Health Care Services, shall exempt from this chapter any county-operated pilot program contracting with the State Department of Health Care Services pursuant to Article 7 (commencing with Section 14490) of Chapter 8 of Part 3 of Division 9 of the Welfare and Institutions Code. The director may exempt noncounty-operated pilot programs upon request of the Director of Health Care Services. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.
(d)Upon the request of the Director of Health Care Services, the director may exempt from this chapter any mental health plan contractor or any capitated rate contract under Chapter 8.9 (commencing with Section 14700) of Part 3 of Division 9 of the Welfare and Institutions Code. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.
(e)This chapter shall not apply to:
(1)A person organized and operating pursuant to a certificate issued by the Insurance Commissioner unless the entity is directly providing the health care service through those entity-owned or contracting health facilities and providers, in which case this chapter shall apply to the insurers plan and to the insurer.
(2)A plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependants, dependents, except that a plan described in this paragraph shall be subject to Section 1367.33 and Senate Bill No. 999 (Ch. 499, Stats. of 2016).
(3)A person who does all of the following:
(A)Promises to provide care for life or for more than one year in return for a transfer of consideration from, or on behalf of, a person 60 years of age or older.
(B)Has obtained a written license pursuant to Chapter 2 (commencing with Section 1250) or Chapter 3.2 (commencing with Section 1569).
(C)Has obtained a certificate of authority from the State Department of Social Services.
(4)The Major Risk Medical Insurance Board when engaging in activities under Chapter 8 (commencing with Section 10700) of Part 2 of Division 2 of the Insurance Code, Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code, and Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code.
(5)The California Small Group Reinsurance Fund.
SEC. 5.Section 1367.25 of the Health and Safety Code is amended to read:1367.25.(a)A group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, and an individual health care service plan contract that is amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, except for a specialized health care service plan contract, shall provide coverage for the following, under general terms and conditions applicable to all benefits:
(1)A health care service plan contract that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods designated by the plan. In the event the patients participating provider, acting within the providers scope of practice, determines that none of the methods designated by the plan is medically appropriate for the patients medical or personal history, the plan shall also provide coverage for another FDA-approved, medically appropriate prescription contraceptive method prescribed by the patients provider.
(2)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(b)(1)A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for all subscribers and enrollees:
(A)Except as provided in subparagraphs (B) and (C) of paragraph (2), all FDA-approved contraceptive drugs, devices, and other products, including all FDA-approved contraceptive drugs, devices, and products available over the counter without a prescription, as follows:
(i)A health care service plan shall not require a prescription to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(ii)A health care service plan is required to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing or medical management restrictions and reimburse enrollees for out-of-pocket costs for over-the-counter birth control methods purchased at any out-of-network pharmacy or retailer in California without medical management restrictions.
(iii)A health care service plan may limit the frequency and define quantities with which the coverage required under this subparagraph is provided.(B)Voluntary sterilization tubal ligation procedures.
(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device removal.
(2)(A)A Except for a grandfathered health care service plan, a health care service plan subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision, except for a grandfathered health plan or a qualifying health plan for a health savings account. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost-sharing for the coverage required pursuant to this subdivision at the minimum level necessary to preserve the enrollees ability to claim tax-exempt contributions and withdrawals from the enrollees health savings account under Internal Revenue Service laws and regulations. subdivision. Cost sharing shall not be imposed on any Medi-Cal beneficiary.
(B)If the FDA has approved one or more therapeutic equivalents of a contraceptive drug, device, or product, a health care service plan is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, a health care service plan is required to provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the enrollees provider, a health care service plan shall defer to the determination and judgment of the attending provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider. The department shall may promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an enrollee, an enrollees designee, or an enrollees provider to request coverage of an alternative prescribed contraceptive. A request by a contracting provider shall be responded to by the health care service plan in compliance with the Knox-Keene Health Care Service Plan Act of 1975, as set forth in this chapter and, as applicable, with the plans Medi-Cal managed care contract.
(3)Except as otherwise authorized under this section, a health care service plan shall not infringe upon an enrollees choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(5)For purposes of this subdivision, health care service plan shall include Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
(c)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for FDA-approved contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(1)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this subdivision shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive health care services the employer refuses to cover for religious reasons.
(d)(1)Every health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an enrollee by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)This subdivision shall not be construed to require a health care service plan contract to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the plans policies governing out-of-network coverage.
(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health care service plan subject to this subdivision, in the absence of clinical contraindications, shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply, and shall not require an enrollee to make any formal request for such coverage other than a pharmacy claim.
(e)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee.
(f)This section shall not be construed to deny or restrict the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(g)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(h)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to health care service plan contracts issued, amended, or renewed on or after January 1, 2016, provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of this code.
(4)For purposes of this section, over-the-counter FDA-approved contraceptive drugs, devices, and products and over-the-counter birth control methods are limited to those included as essential health benefits pursuant to Section 1367.005.
(i)The changes made to this section by the act that added this subdivision apply only to a health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2022.
SEC. 6.Section 1367.255 is added to the Health and Safety Code, immediately following section 1367.25, to read:1367.255.(a)(1)A health care service plan contract issued, amended, renewed, or delivered on or after January 1, 2022, except for a grandfathered health plan or a qualifying health plan for a health savings account, shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy coverage provided under the essential health benefits pursuant to Section 1367.005. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost-sharing for the coverage required pursuant to this section and Section 1367.005 at the minimum level necessary to preserve the enrollees ability to claim tax-exempt contributions and withdrawals from the enrollees health savings account under Internal Revenue Service laws and regulations. Cost sharing shall not be imposed on a Medi-Cal beneficiary.
(2)A health care service plan shall not impose any restrictions or delays on the coverage required under this subdivision.
(3)Benefits for an enrollee under this section shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(4)For purposes of this section, health care service plan includes Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
(b)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for vasectomy services and procedures. The exclusion from coverage under this provision shall not apply to a vasectomy service or procedure that is used for purposes other than contraception.
(1)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing vasectomy as a service or procedure that the employer refuses to cover for religious reasons.
(c)This section shall not be construed to deny or restrict in any way the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(d)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(e)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)Provider means an individual who is certified or licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
SEC. 6.SEC. 7.Section 1367.33 is added to the Health and Safety Code, to read:1367.33.Notwithstanding any other law, a plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, and that is approved on or after January 1, 2023, shall comply with the contraceptive coverage requirements of Section 1367.25 Sections 1367.25 and 1367.255 and Senate Bill No. 999 (Ch. 499, Stats. 2016).
SEC. 8.Section 10123.1945 is added to the Insurance Code, immediately following Section 10123.194, to read:10123.1945.(a)(1)A disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2022, except for a grandfathered health plan or a qualifying health plan for a health savings account, shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy coverage provided under the essential health benefits pursuant to Section 10112.27. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost-sharing for the coverage required pursuant to this section and Section 10112.27 at the minimum level necessary to preserve the insureds ability to claim tax-exempt contributions and withdrawals from the insureds health savings account under Internal Revenue Service laws and regulations.
(2)An insurer shall not impose any restrictions or delays on the coverage required under this subdivision.
(3)Coverage with respect to an insured under this section shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)This section shall not be construed to deny or restrict in any way an existing right or benefit provided under law or by contract.
(c)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(d)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for vasectomy services and procedures. The exclusion from coverage under this provision shall not apply to a vasectomy service or procedure that is used for purposes other than contraception.
(1)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this section shall provide written notice to a prospective employee once an offer of employment has been made, and prior to that person commencing that employment, listing vasectomy as a service or procedure that the employer refuses to cover for religious reasons.
(e)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(f)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)Health care provider means an individual who is certified or licensed practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
SEC. 7.SEC. 9.Section 10123.196 of the Insurance Code is amended to read:10123.196.(a)An individual or group policy of disability insurance issued, amended, renewed, or delivered on or after January 1, 2000, through December 31, 2015, inclusive, that provides coverage for hospital, medical, or surgical expenses, shall provide coverage for the following, under the same terms and conditions as applicable to all benefits:
(1)A disability insurance policy that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods, as designated by the insurer. If an insureds health care provider determines that none of the methods designated by the disability insurer is medically appropriate for the insureds medical or personal history, the insurer shall, in the alternative, provide coverage for some other FDA-approved prescription contraceptive method prescribed by the patients health care provider.
(2)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for all policyholders and insureds:
(A)Except as provided in subparagraphs (B) and (C) of paragraph (2), all FDA-approved, contraceptive drugs, devices, and other products, including all FDA-approved, contraceptive drugs, devices, and products available over the counter without a prescription, as follows:
(i)A health insurer shall not require a prescription to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(ii)A health insurer is required to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing or medical management restrictions and reimburse insureds for out-of-pocket costs for over-the-counter birth control methods purchased at any out-of-network pharmacy or retailer in California without medical management restrictions.
(iii)A health care insurer may limit the frequency and define quantities with which the coverage required under this subparagraph is provided.(B)Voluntary sterilization tubal ligation procedures.
(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device removal.
(2)(A)A Except for a grandfathered health plan, a disability insurer subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision, except for a grandfathered health plan or a qualifying health plan for a health savings account. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost-sharing for the coverage required pursuant to this subdivision at the minimum level necessary to preserve the insureds ability to claim tax exempt contributions and withdrawals from the insureds health savings account under Internal Revenue Service laws and regulations. subdivision.
(B)If the FDA has approved one or more therapeutic equivalents of a contraceptive drug, device, or product, a disability insurer is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, a health care service plan is required to provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the insureds provider, a disability insurer shall defer to the determination and judgment of the attending provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider. The department shall may promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an insured, an insureds designee or an insureds provider to request coverage of an alternative prescribed contraceptive. A request by a contracting provider shall be responded to by the disability insurer in compliance with Section 10123.191.
(3)Except as otherwise authorized under this section, an insurer shall not infringe upon an insureds choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(c)This section shall not be construed to deny or restrict in any way any existing right or benefit provided under law or by contract.
(d)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(e)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(1)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this subdivision shall provide written notice to prospective insureds prior to obtaining coverage under the policy, listing the contraceptive health care services the employer refuses to cover for religious reasons.
(f)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an insured by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)This subdivision shall not be construed to require a policy to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the insurers policies governing out-of-network coverage.
(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health insurer subject to this subdivision, in the absence of clinical contraindications, shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply, and shall not require an insured to make any formal request for such coverage other than a pharmacy claim.
(g)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an insured.
(h)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(i)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to policies of disability insurance issued, amended, or renewed on or after January 1, 2016, health care provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
(4)For purposes of this section, over-the-counter FDA-approved contraceptive drugs, devices, and products and over-the-counter birth control methods are limited to those included as essential health benefits pursuant to Section 10112.27.
(j)The changes made to this section by the act that added this subdivision apply only to a health insurance policy that is issued, amended, renewed, or delivered on or after January 1, 2022.
SEC. 8.SEC. 10.Section 10127.20 is added to the Insurance Code, to read:10127.20.Notwithstanding any other law, a policy directly issued by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, that is approved on or after January 1, 2023, shall comply with the contraceptive coverage requirements of Section 10123.196 Sections 10123.1945 and 10123.196, and Senate Bill No. 999 (Ch. 499, Stats. 2016).
SEC. 9.Section 2810.8 is added to the Labor Code, to read:2810.8.SEC. 11.Section 2810.9 is added to the Labor Code, to read:2810.9.(a)An employer shall not fail or refuse to hire or discharge any individual or otherwise discriminate or take any retaliatory personnel action against any employee with respect to compensation, terms, conditions, or privileges of employment because of the employees or their dependents reproductive health decisionmaking, including a decision to use or access a particular drug, device, or medical service.
(b)An employer, or any person acting on behalf of an employer, who takes any adverse employment action against an employee in violation of subdivision (a) is liable to the aggrieved employee, who shall recover a penalty pursuant to Section 98.6 and obtain any other appropriate relief to remedy the violation, including reinstatement, reimbursement of lost wages and interest thereon, and other compensation or equitable relief appropriate to the circumstances.
(c)Any contract or agreement, express or implied, made by an employee to waive the benefits of this section is null and void.
(d)An employer that requires compliance with an employee handbook shall include in the handbook notice of the employee rights and remedies under this section.
(e)The rights and remedies conferred by this section are in addition to, and not in limitation of, any right or remedy lawfully granted under the California Fair Employment and Housing Act (Part 2.8 (commencing with Section 12900) of Division 3 of Title 2 of the Government Code).
(f)This section does not create a new basis upon which an employee can accrue or use benefits relating to paid or protected time off.
SEC. 10.SEC. 12.Section 10509.5 is added to the Public Contract Code, to read:10509.5.Notwithstanding any other law, commencing January 1, 2022, the University of California shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Section 1367.25 of the Health and Safety Code, Section 10123.196 Sections 1367.25 and 1367.255 of the Health and Safety Code, Sections 10123.1945 and 10123.196 of the Insurance Code, and Senate Bill No. 999 (Ch. 499, Stats. 2016).
SEC. 11.SEC. 13.Section 10828 is added to the Public Contract Code, to read:10828.Notwithstanding any other law, commencing January 1, 2022, the California State University shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Section 1367.25 of the Health and Safety Code, Section 10123.196 Sections 1367.25 and 1367.255 of the Health and Safety Code, Sections 10123.1945 and 10123.196 of the Insurance Code, and Senate Bill No. 999 (Ch. 499, Stats. 2016).
SEC. 12.SEC. 14.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
This act shall be known, and may be cited, as the Contraceptive Equity Act of 2021.
SEC. 2.The Legislature finds and declares all of the following:
(a) California has a long history of expanding timely access to birth control to prevent unintended pregnancy. Thanks to a combination of innovative policies and programs enacted statewide, unintended pregnancy rates are at a 30-year low.
(b) Despite the progress made, health disparities in reproductive health outcomes persist among Black, Indigenous and People of Color, including disproportionate unintended pregnancy, infant and maternal mortality, and (STD) rates. The legislature must take action to ensure that all Californians have equitable access to preventive contraceptive care.
(c) The federal Patient Protection and Affordable Care Act (Public Law 111-148) included a mandate that most health insurance plans cover contraception without out-of-pocket costs for patients.
(d)Californias Contraceptive Coverage Equity Act of 2014 and the Annual Supply of Contraceptives Act of 2016, built on this federal policy and existing state law to be the first state in the country to require coverage of birth control methods approved by the federal Food and Drug Administration for women without cost-sharing or restrictions and a 12-month supply of self-administered birth control dispensed at one time for individuals enrolled in health insurance plans and policies regulated by the Keene Health Care Service Act of 1975.
(e) Since 2014, several other states have expanded on Californias model legislation to create more equitable contraceptive coverage and access by requiring most health insurance plans and policies to cover voluntary sterilization services and all birth control methods available over-the-counter without a prescription for all beneficiaries, regardless of gender.
(f) A report by the Guttmacher Institute shows that vasectomy is among the most effective and cost-effective contraceptive methods available.
(g) Trump-era attacks on birth control access have underscored the need to codify the expansion of contraceptive coverage for as many Californians as possible under state law.
(h) The COVID-19 public health emergency has also further illuminated the structural inequities that disproportionately affect youth, low-income people and communities of color in accessing birth control services. A report by the Guttmacher Institute revealed that 29 percent of White women, 38 percent of Black women and 45 percent of Latinas now face difficulties accessing birth control as a result of the pandemic.
(i) The COVID-19 pandemic has exacerbated rates of sexually transmitted diseases STDs in California and across the country that were already skyrocketing to epidemic proportions prior to the public health emergency. Condoms are the only birth control method that also reduce STD transmission rates.
(j) The Legislature intends to reduce sexual and reproductive health disparities and ensure greater health equity by providing a pathway for more Californians to get the contraceptive care they want, when they need it without inequitable delays or cost barriers. This includes a pathway to no-cost coverage for Californians whose employer-based health insurance plan may exclude contraceptive care under existing California law.
(k) The Legislature intends for the relevant California departments and agencies to work in concert to ensure compliance with these provisions.
SEC. 3.Section 22856 is added to the Government Code, to read:22856.Notwithstanding any other law, commencing January 1, 2022, the board shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Section 1367.25 of the Health and Safety Code, Section 10123.196 of the Insurance Code, and Senate Bill No. 999 (Ch. 499, Stats. 2016).
SEC. 4.Section 1343 of the Health and Safety Code is amended to read:1343.(a)This chapter shall apply to health care service plans and specialized health care service plan contracts as defined in subdivisions (f) and (o) of Section 1345.
(b)The director may by the adoption of rules or the issuance of orders deemed necessary and appropriate, either unconditionally or upon specified terms and conditions or for specified periods, exempt from this chapter any class of persons or plan contracts if the director finds the action to be in the public interest and not detrimental to the protection of subscribers, enrollees, or persons regulated under this chapter, and that the regulation of the persons or plan contracts is not essential to the purposes of this chapter.
(c)The director, upon request of the Director of Health Care Services, shall exempt from this chapter any county-operated pilot program contracting with the State Department of Health Care Services pursuant to Article 7 (commencing with Section 14490) of Chapter 8 of Part 3 of Division 9 of the Welfare and Institutions Code. The director may exempt noncounty-operated pilot programs upon request of the Director of Health Care Services. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.
(d)Upon the request of the Director of Health Care Services, the director may exempt from this chapter any mental health plan contractor or any capitated rate contract under Chapter 8.9 (commencing with Section 14700) of Part 3 of Division 9 of the Welfare and Institutions Code. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.
(e)This chapter shall not apply to:
(1)A person organized and operating pursuant to a certificate issued by the Insurance Commissioner unless the entity is directly providing the health care service through those entity-owned or contracting health facilities and providers, in which case this chapter shall apply to the insurers plan and to the insurer.
(2)A plan directly operated by a bona fide public or private institution of higher learning which that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents. dependants, except that a plan described in this paragraph shall be subject to Section 1367.33 and Senate Bill No. 999 (Ch. 499, Stats. of 2016).
(3)A person who does all of the following:
(A)Promises to provide care for life or for more than one year in return for a transfer of consideration from, or on behalf of, a person 60 years of age or older.
(B)Has obtained a written license pursuant to Chapter 2 (commencing with Section 1250) or Chapter 3.2 (commencing with Section 1569).
(C)Has obtained a certificate of authority from the State Department of Social Services.
(4)The Major Risk Medical Insurance Board when engaging in activities under Chapter 8 (commencing with Section 10700) of Part 2 of Division 2 of the Insurance Code, Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code, and Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code.
(5)The California Small Group Reinsurance Fund.
SEC. 4.SEC. 5.Section 1367.25 of the Health and Safety Code is amended to read:1367.25.(a)A group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, and an individual health care service plan contract that is amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, except for a specialized health care service plan contract, shall provide coverage for the following, under general terms and conditions applicable to all benefits:
(1)A health care service plan contract that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods designated by the plan. In the event the patients participating provider, acting within the providers scope of practice, determines that none of the methods designated by the plan is medically appropriate for the patients medical or personal history, the plan shall also provide coverage for another FDA-approved, medically appropriate prescription contraceptive method prescribed by the patients provider.
(2)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(b)(1)A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for all subscribers and enrollees:
(A)Except as provided in subparagraphs (B) and (C) of paragraph (2), all FDA-approved contraceptive drugs, devices, and other products, including all FDA-approved contraceptive drugs, devices, and products available over the counter without a prescription, as follows:
(i)A health care service plan shall not require a prescription to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(ii)A health care service plan is required to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing or medical management restrictions and reimburse enrollees for out-of-pocket costs for over-the-counter birth control methods purchased at any out-of-network pharmacy or retailer in California without medical management restrictions.
(iii)A health care service plan may limit the frequency and define quantities with which the coverage required under this subparagraph is provided.
(B)Voluntary sterilization procedures.
(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device insertion and removal.
(2)(A)A health care service plan subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision, except for a grandfathered health plan or a qualifying health plan for a health savings account. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost-sharing for the coverage required pursuant to this subdivision at the minimum level necessary to preserve the enrollees ability to claim tax-exempt contributions and withdrawals from the enrollees health savings account under Internal Revenue Service laws and regulations. Cost sharing shall not be imposed on any Medi-Cal beneficiary.
(B)If the FDA has approved one or more therapeutic equivalents of a contraceptive drug, device, or product, a health care service plan is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, a health care service plan is required to provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the enrollees provider, a health care service plan shall defer to the determination and judgment of the attending provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider. The department shall promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an enrollee, an enrollees designee, or an enrollees provider to request coverage of an alternative prescribed contraceptive. A request by a contracting provider shall be responded to by the health care service plan in compliance with the Knox-Keene Health Care Service Plan Act of 1975, as set forth in this chapter and, as applicable, with the plans Medi-Cal managed care contract.
(3)Except as otherwise authorized under this section, a health care service plan shall not infringe upon an enrollees choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(5)For purposes of this subdivision, health care service plan shall include Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
(c)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for FDA-approved contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(1)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this subdivision shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive health care services the employer refuses to cover for religious reasons.
(3)A religious employer that invokes the exemption under this subdivision may not discriminate, fire, or enforce other workplace punishment against an employee based on the employees decision to independently obtain contraceptive coverage, care, or prescriptions outside of the employer-based plan.(d)(1)Every health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an enrollee by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)This subdivision shall not be construed to require a health care service plan contract to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the plans policies governing out-of-network coverage.
(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health care service plan subject to this subdivision, in the absence of clinical contraindications, shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply. supply, and shall not require an enrollee to make any formal request for such coverage other than a pharmacy claim.
(e)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee.
(f)This section shall not be construed to deny or restrict the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(g)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(h)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to health care service plan contracts issued, amended, or renewed on or after January 1, 2016, provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of this code.
(i)The changes made to this section by the act that added this subdivision apply only to a health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2022.
SEC. 6.Section 1367.33 is added to the Health and Safety Code, to read:1367.33.Notwithstanding any other law, a plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, and that is approved on or after January 1, 2023, shall comply with the contraceptive coverage requirements of Section 1367.25 and Senate Bill No. 999 (Ch. 499, Stats. 2016).
SEC. 5.SEC. 7.Section 10123.196 of the Insurance Code is amended to read:10123.196.(a)An individual or group policy of disability insurance issued, amended, renewed, or delivered on or after January 1, 2000, through December 31, 2015, inclusive, that provides coverage for hospital, medical, or surgical expenses, shall provide coverage for the following, under the same terms and conditions as applicable to all benefits:
(1)A disability insurance policy that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods, as designated by the insurer. If an insureds health care provider determines that none of the methods designated by the disability insurer is medically appropriate for the insureds medical or personal history, the insurer shall, in the alternative, provide coverage for some other FDA-approved prescription contraceptive method prescribed by the patients health care provider.
(2)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for all policyholders and insureds:
(A)Except as provided in subparagraphs (B) and (C) of paragraph (2), all FDA-approved, contraceptive drugs, devices, and other products, including all FDA-approved, contraceptive drugs, devices, and products available over the counter without a prescription, as follows:
(i)A health insurer shall not require a prescription to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(ii)A health insurer is required to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing or medical management restrictions and reimburse insureds for out-of-pocket costs for over-the-counter birth control methods purchased at any out-of-network pharmacy or retailer in California without medical management restrictions.
(iii)A health care insurer may limit the frequency and define quantities with which the coverage required under this subparagraph is provided.
(B)Voluntary sterilization procedures.
(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device insertion and removal.
(2)(A)A disability insurer subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision, except for a grandfathered health plan or a qualifying health plan for a health savings account. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost-sharing for the coverage required pursuant to this subdivision at the minimum level necessary to preserve the insureds ability to claim tax exempt contributions and withdrawals from the insureds health savings account under Internal Revenue Service laws and regulations.
(B)If the FDA has approved one or more therapeutic equivalents of a contraceptive drug, device, or product, a disability insurer is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, a health care service plan is required to provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the insureds provider, a disability insurer shall defer to the determination and judgment of the attending provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider. The department shall promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an insured, an insureds designee or an insureds provider to request coverage of an alternative prescribed contraceptive. A request by a contracting provider shall be responded to by the disability insurer in compliance with Section 10123.191.
(3)Except as otherwise authorized under this section, an insurer shall not infringe upon an insureds choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(c)This section shall not be construed to deny or restrict in any way any existing right or benefit provided under law or by contract. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(d)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(e)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(1)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this subdivision shall provide written notice to prospective insureds prior to obtaining coverage under the policy, listing the contraceptive health care services the employer refuses to cover for religious reasons.
(3)A religious employer that invokes the exemption under this subdivision may not discriminate, fire, or enforce other workplace punishment against an employee based on the employees decision to independently obtain contraceptive coverage, care, or prescriptions outside of the employer-based policy.(f)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an insured by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)This subdivision shall not be construed to require a policy to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the insurers policies governing out-of-network coverage.
(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health insurer subject to this subdivision, in the absence of clinical contraindications, shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply. supply, and shall not require an insured to make any formal request for such coverage other than a pharmacy claim.
(g)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an insured.
(h)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(i)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to policies of disability insurance issued, amended, or renewed on or after January 1, 2016, health care provider means an individual who is certified or licensed to furnish family planning services within their scope of practice pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, including a pharmacist authorized pursuant to Section 4052 or 4052.3 of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
(j)The changes made to this section by the act that added this subdivision apply only to a health insurance policy that is issued, amended, renewed, or delivered on or after January 1, 2022.
SEC. 8.Section 10127.20 is added to the Insurance Code, to read:10127.20.Notwithstanding any other law, a policy directly issued by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, that is approved on or after January 1, 2023, shall comply with the contraceptive coverage requirements of Section 10123.196 and Senate Bill No. 999 (Ch. 499, Stats. 2016).
SEC. 9.Section 2810.8 is added to the Labor Code, to read:2810.8.(a)An employer shall not fail or refuse to hire or discharge any individual or otherwise discriminate or take any retaliatory personnel action against any employee with respect to compensation, terms, conditions, or privileges of employment because of the employees or their dependents reproductive health decisionmaking, including a decision to use or access a particular drug, device, or medical service.
(b)An employer, or any person acting on behalf of an employer, who takes any adverse employment action against an employee in violation of subdivision (a) is liable to the aggrieved employee, who shall recover a penalty pursuant to Section 98.6 and obtain any other appropriate relief to remedy the violation, including reinstatement, reimbursement of lost wages and interest thereon, and other compensation or equitable relief appropriate to the circumstances.
(c)Any contract or agreement, express or implied, made by an employee to waive the benefits of this section is null and void.
(d)An employer that requires compliance with an employee handbook shall include in the handbook notice of the employee rights and remedies under this section.
(e)The rights and remedies conferred by this section are in addition to, and not in limitation of, any right or remedy lawfully granted under the California Fair Employment and Housing Act (Part 2.8 (commencing with Section 12900) of Division 3 of Title 2 of the Government Code).
(f)This section does not create a new basis upon which an employee can accrue or use benefits relating to paid or protected time off.
SEC. 6.SEC. 10.Section 10509.5 is added to the Public Contract Code, to read:10509.5.Notwithstanding any other law, commencing January 1, 2022, the University of California shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Section 1367.25 of the Health and Safety Code, Section 10123.196 of the Insurance Code, and Senate Bill No. 999 (Ch. 499, Stats. 2016).
SEC. 11.Section 10828 is added to the Public Contract Code, to read:10828.Notwithstanding any other law, commencing January 1, 2022, the California State University shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Section 1367.25 of the Health and Safety Code, Section 10123.196 of the Insurance Code, and Senate Bill No. 999 (Ch. 499, Stats. 2016).
SEC. 7.SEC. 12.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
This act shall be known, and may be cited, as the Contraceptive Equity Act of 2021.
SEC. 2.The Legislature finds and declares all of the following:
(a) California has a long history of expanding timely access to birth control to prevent unintended pregnancy. Thanks to a combination of innovative policies and programs enacted statewide, unintended pregnancy rates are at a 30-year low.
(b) Despite the progress made, health disparities in reproductive health outcomes persist among Black, Indigenous and People of Color, including disproportionate unintended pregnancy, infant and maternal mortality, and (STD) rates. The legislature must take action to ensure that all Californians have equitable access to preventive contraceptive care.
(c) The federal Patient Protection and Affordable Care Act (Public Law 111-148) included a mandate that most health insurance plans cover contraception without out-of-pocket costs for patients.
(d)Californias Contraceptive Coverage Equity Act of 2014 and the Annual Supply of Contraceptives Act of 2016, built on this federal policy and existing state law to be the first state in the country to require coverage of birth control methods approved by the federal Food and Drug Administration for women without cost-sharing or restrictions and a 12-month supply of self-administered birth control dispensed at one time for individuals enrolled in health insurance plans and policies regulated by the Keene Health Care Service Act of 1975.
(e) Since 2014, several other states have expanded on Californias model legislation to create more equitable contraceptive coverage and access by requiring most health insurance plans and policies to cover voluntary sterilization services and all birth control methods available over-the-counter without a prescription for all beneficiaries, regardless of gender.
(f) A report by the Guttmacher Institute shows that vasectomy is among the most effective and cost-effective contraceptive methods available.
(g) Trump-era attacks on birth control access have underscored the need to codify the expansion of contraceptive coverage for as many Californians as possible under state law.
(h) The COVID-19 public health emergency has also further illuminated the structural inequities that disproportionately affect youth, low-income people and communities of color in accessing birth control services. A report by the Guttmacher Institute revealed that 29 percent of White women, 38 percent of Black women and 45 percent of Latinas now face difficulties accessing birth control as a result of the pandemic.
(i) The COVID-19 pandemic has exacerbated rates of sexually transmitted diseases STDs in California and across the country that were already skyrocketing to epidemic proportions prior to the public health emergency. Condoms are the only birth control method that also reduce STD transmission rates.
(j) The Legislature intends to reduce sexual and reproductive health disparities and ensure greater health equity by providing a pathway for more Californians to get the contraceptive care they want, when they need it without inequitable delays or cost barriers. This includes a pathway to no-cost coverage for Californians whose employer-based health insurance plan may exclude contraceptive care under existing California law.
(k) The Legislature intends for the relevant California departments and agencies to work in concert to ensure compliance with these provisions.
SEC. 3.Section 22856 is added to the Government Code, to read:22856.Notwithstanding any other law, commencing January 1, 2022, the board shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Section 1367.25 of the Health and Safety Code, Section 10123.196 of the Insurance Code, and Senate Bill No. 999 (Ch. 499, Stats. 2016).
SEC. 4.Section 1367.25 of the Health and Safety Code is amended to read:1367.25.(a)A group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, and an individual health care service plan contract that is amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, except for a specialized health care service plan contract, shall provide coverage for the following, under general terms and conditions applicable to all benefits:
(1)A health care service plan contract that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods designated by the plan. In the event the patients participating provider, acting within the providers scope of practice, determines that none of the methods designated by the plan is medically appropriate for the patients medical or personal history, the plan shall also provide coverage for another FDA-approved, medically appropriate prescription contraceptive method prescribed by the patients provider.
(2)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(b)(1)A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for all subscribers and enrollees:
(A)Except as provided in subparagraphs (B) and (C) of paragraph (2), all FDA-approved contraceptive drugs, devices, and other products, including all FDA-approved contraceptive drugs, devices, and products available over the counter without a prescription, as follows:
(i)A health care service plan shall not require a prescription to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(ii)A health care service plan is required to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing or medical management restrictions and reimburse enrollees for out-of-pocket costs for over-the-counter birth control methods purchased at any out-of-network pharmacy in California without medical management restrictions.
(iii)A health care service plan may limit the frequency and define quantities with which the coverage required under this subparagraph is provided.
(B)Voluntary sterilization procedures.
(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, ultrasound, anesthesia, patient education, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device insertion and removal.
(2)(A)A health care service plan subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision, except for a grandfathered health plan or a qualifying health plan for a health savings account. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost-sharing for the coverage required pursuant to this subdivision at the minimum level necessary to preserve the enrollees ability to claim tax-exempt contributions and withdrawals from the enrollees health savings account under Internal Revenue Service laws and regulations. Cost sharing shall not be imposed on any Medi-Cal beneficiary.
(B)If the FDA has approved one or more therapeutic equivalents of a contraceptive drug, device, or product, a health care service plan is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, a health care service plan is required to provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the enrollees provider, a health care service plan shall defer to the determination and judgment of the attending provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider. The department shall promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an enrollee, an enrollees designee, or an enrollees provider to request coverage of an alternative prescribed contraceptive. A request by a contracting provider shall be responded to by the health care service plan in compliance with the Knox-Keene Health Care Service Plan Act of 1975, as set forth in this chapter and, as applicable, with the plans Medi-Cal managed care contract.
(3)Except as otherwise authorized under this section, a health care service plan shall not infringe upon an enrollees choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(5)For purposes of this subdivision, health care service plan shall include Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
(c)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for FDA-approved contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(1)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)If a religious employer makes an election under this section not to purchase coverage for contraceptive methods, all of the following shall apply:(A)The religious employer shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive health care services the employer refuses to cover for religious reasons.(B)An employee may submit a request for no-cost contraceptive care coverage to the health care service plan, drugs, devices, products, and procedures. If a request is received, the health care service plan shall provide no-cost contraceptive coverage following the requirements of this section and provisions outlined in Senate Bill No. 999 (Ch. 499, Stats. 2016).(C)The health care service plan shall be reimbursed by the state for contraceptive care, services, drugs, devices, products, and procedures provided to employees under this provision. This subparagraph shall cease to be implemented on July 1, 2023, unless the department determines that date may be extended based on utilization demand and need, and subject to an appropriation by the Legislature for that purpose.(2)Every religious employer that invokes the exemption provided under this subdivision shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive health care services the employer refuses to cover for religious reasons.
(D)(3)A religious employer that invokes the exemption under this subparagraph subdivision may not discriminate, fire, or enforce other workplace punishment against an employee based on the employees decision to independently obtain contraceptive coverage, care, or prescriptions outside of the employer-based plan.
(d)(1)Every health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an enrollee by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)This subdivision shall not be construed to require a health care service plan contract to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the plans policies governing out-of-network coverage.
(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health care service plan subject to this subdivision, in the absence of clinical contraindications, shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply.
(e)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee.
(f)This section shall not be construed to deny or restrict the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(g)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(h)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to health care service plan contracts issued, amended, or renewed on or after January 1, 2016, provider means an individual who is certified or licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of this code.
(i)The changes made to this section by the act that added this subdivision apply only to a health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2022.
SEC. 5.Section 10123.196 of the Insurance Code is amended to read:10123.196.(a)An individual or group policy of disability insurance issued, amended, renewed, or delivered on or after January 1, 2000, through December 31, 2015, inclusive, that provides coverage for hospital, medical, or surgical expenses, shall provide coverage for the following, under the same terms and conditions as applicable to all benefits:
(1)A disability insurance policy that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods, as designated by the insurer. If an insureds health care provider determines that none of the methods designated by the disability insurer is medically appropriate for the insureds medical or personal history, the insurer shall, in the alternative, provide coverage for some other FDA-approved prescription contraceptive method prescribed by the patients health care provider.
(2)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for all policyholders and insureds:
(A)Except as provided in subparagraphs (B) and (C) of paragraph (2), all FDA-approved, contraceptive drugs, devices, and other products, including all FDA-approved, contraceptive drugs, devices, and products available over the counter without a prescription, as follows:
(i)A health insurer shall not require a prescription to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(ii)A health insurer is required to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing or medical management restrictions and reimburse insureds for out-of-pocket costs for over-the-counter birth control methods purchased at any out-of-network pharmacy in California without medical management restrictions.
(iii)A health care insurer may limit the frequency and define quantities with which the coverage required under this subparagraph is provided.
(B)Voluntary sterilization procedures.
(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, ultrasound, anesthesia, patient education, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device insertion and removal.
(2)(A)A disability insurer subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision, except for a grandfathered health plan or a qualifying health plan for a health savings account. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost-sharing for the coverage required pursuant to this subdivision at the minimum level necessary to preserve the insureds ability to claim tax exempt contributions and withdrawals from the insureds health savings account under Internal Revenue Service laws and regulations.
(B)If the FDA has approved one or more therapeutic equivalents of a contraceptive drug, device, or product, a disability insurer is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, a health care service plan is required to provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is deemed medically inadvisable by the insureds provider, a disability insurer shall defer to the determination and judgment of the attending provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider. The department shall promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an insured, an insureds designee or an insureds provider to request coverage of an alternative prescribed contraceptive. A request by a contracting provider shall be responded to by the disability insurer in compliance with Section 10123.191.
(3)Except as otherwise authorized under this section, an insurer shall not infringe upon an insureds choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(c)This section shall not be construed to deny or restrict in any way any existing right or benefit provided under law or by contract. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(d)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(e)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for contraceptive methods.
(1)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)If a religious employer makes an election under this section not to purchase coverage for contraceptive methods, all of the following shall apply:(A)The religious employer shall provide written notice to prospective insured prior to enrollment with the plan, listing the contraceptive health care services the employer refuses to cover for religious reasons.(B)An employee may submit a request for no-cost contraceptive care coverage to the disability insurer, drugs, devices, products, and procedures. If a request is received, the health care service plan shall provide no-cost contraceptive coverage following the requirements of this section and provisions outlined in Senate Bill No. 999 (Ch. 499, Stats. 2016).(C)The health care service plan shall be reimbursed by the state for contraceptive care, services, drugs, devices, products, and procedures provided to employees under this provision. This subparagraph shall cease to be implemented on July 1, 2023, unless the department determines that date may be extended based on utilization demand and need, and subject to an appropriation by the Legislature for that purpose.(2)Every religious employer that invokes the exemption provided under this subdivision shall provide written notice to prospective insureds prior to obtaining coverage under the policy, listing the contraceptive health care services the employer refuses to cover for religious reasons.
(D)(3)A religious employer that invokes the exemption under this subparagraph subdivision may not discriminate, fire, or enforce other workplace punishment against an employee based on the employees decision to independently obtain contraceptive coverage, care, or prescriptions outside of the employer-based plan. policy.
(f)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an insured by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)This subdivision shall not be construed to require a policy to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the insurers policies governing out-of-network coverage.
(3)This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health insurer subject to this subdivision, in the absence of clinical contraindications, shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply.
(g)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an insured.
(h)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(i)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to policies of disability insurance issued, amended, or renewed on or after January 1, 2016, health care provider means an individual who is certified or licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
(j)The changes made to this section by the act that added this subdivision apply only to a health insurance policy that is issued, amended, renewed, or delivered on or after January 1, 2022.
SEC. 6.Section 10509.5 is added to the Public Contract Code, to read:10509.5.Notwithstanding any other law, commencing January 1, 2022, the University of California shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Section 1367.25 of the Health and Safety Code, Section 10123.196 of the Insurance Code, and Senate Bill No. 999 (Ch. 499, Stats. 2016).
SEC. 7.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
This act shall be known, and may be cited, as the Contraceptive Equity Act of 2021.
SEC. 2.The Legislature finds and declares all of the following:
(a) California has a long history of expanding timely access to birth control to prevent unintended pregnancy. Thanks to a combination of innovative policies and programs enacted statewide, unintended pregnancy rates are at a 30-year low.
(b) Despite the progress made, health disparities in reproductive health outcomes persist among Black, Indigenous and People of Color, including disproportionate unintended pregnancy, infant and maternal mortality, and (STD) rates. The legislature must take action to ensure that all Californians have equitable access to preventive contraceptive care.
(c) The federal Patient Protection and Affordable Care Act (Public Law 111-148) included a mandate that most health insurance plans cover contraception without out-of-pocket costs for patients.
(d)Californias Contraceptive Coverage Equity Act of 2014 and the Annual Supply of Contraceptives Act of 2016, built on this federal policy and existing state law to be the first state in the country to require coverage of birth control methods approved by the federal Food and Drug Administration for women without cost-sharing or restrictions and a 12-month supply of self-administered birth control dispensed at one time for individuals enrolled in health insurance plans and policies regulated by the Keene Health Care Service Act of 1975.
(e) Since 2014, several other states have expanded on Californias model legislation to create more equitable contraceptive coverage and access by requiring most health insurance plans and policies to cover voluntary sterilization services and all birth control methods available over-the-counter without a prescription for all beneficiaries, regardless of gender.
(f) A report by the Guttmacher Institute shows that vasectomy is among the most effective and cost-effective contraceptive methods available.
(g) Trump-era attacks on birth control access have underscored the need to codify the expansion of contraceptive coverage for as many Californians as possible under state law.
(h) The COVID-19 public health emergency has also further illuminated the structural inequities that disproportionately affect youth, low-income people and communities of color in accessing birth control services. A report by the Guttmacher Institute revealed that 29 percent of White women, 38 percent of Black women and 45 percent of Latinas now face difficulties accessing birth control as a result of the pandemic.
(i) The COVID-19 pandemic has exacerbated rates of sexually transmitted diseases STDs in California and across the country that were already skyrocketing to epidemic proportions prior to the public health emergency. Condoms are the only birth control method that also reduce STD transmission rates.
(j) The Legislature intends to reduce sexual and reproductive health disparities and ensure greater health equity by providing a pathway for more Californians to get the contraceptive care they want, when they need it without inequitable delays or cost barriers. This includes a pathway to no-cost coverage for Californians whose employer-based health insurance plan may exclude contraceptive care under existing California law.
(k) The Legislature intends for the relevant California departments and agencies to work in concert to ensure compliance with these provisions.
SEC. 3.Section 22856 is added to the Government Code, to read:22856.Notwithstanding any other law, commencing January 1, 2022, the board shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Section 1367.25 of the Health and Safety Code, Section 10123.196 of the Insurance Code, and Senate Bill No. 999 (Ch. 499, Stats. 2016).
SEC. 4.Section 1367.25 of the Health and Safety Code is amended to read:1367.25.(a)A group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, and an individual health care service plan contract that is amended, renewed, or delivered on or after January 1, 2000, to December 31, 2015, inclusive, except for a specialized health care service plan contract, shall provide coverage for the following, under general terms and conditions applicable to all benefits:
(1)A health care service plan contract that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods designated by the plan. In the event the patients participating provider, acting within his or her the providers scope of practice, determines that none of the methods designated by the plan is medically appropriate for the patients medical or personal history, the plan shall also provide coverage for another FDA-approved, medically appropriate prescription contraceptive method prescribed by the patients provider.
(2)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(b)(1)A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for women: all subscribers and enrollees:
(A)Except as provided in subparagraphs (B) and (C) of paragraph (2), all FDA-approved contraceptive drugs, devices, and other products for women, products, including all FDA-approved contraceptive drugs, devices, and products available over the counter, as prescribed by the enrollees provider. counter without a prescription, as follows:
(i)A health care service plan shall not require a prescription to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(ii)A health care service plan is required to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing or medical management restrictions and reimburse enrollees for out-of-pocket costs for over-the-counter birth control methods purchased at any out-of-network pharmacy in California without medical management restrictions.
(iii)A health care service plan may limit the frequency and define quantities with which the coverage required under this subparagraph is provided.
(B)Voluntary sterilization procedures.
(C)Patient education and counseling on contraception.(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, ultrasound, anesthesia, patient education, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device insertion and removal.
(2)(A)Except for a grandfathered health plan, a A health care service plan subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision. subdivision, except for a grandfathered health plan or a qualifying health plan for a health savings account. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost-sharing for the coverage required pursuant to this subdivision at the minimum level necessary to preserve the enrollees ability to claim tax-exempt contributions and withdrawals from the enrollees health savings account under Internal Revenue Service laws and regulations. Cost sharing shall not be imposed on any Medi-Cal beneficiary.
(B)If the FDA has approved one or more therapeutic equivalents of a contraceptive drug, device, or product, a health care service plan is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, a health care service plan is required to provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is not available, or is deemed medically inadvisable by the enrollees provider, a health care service plan shall provide coverage, subject to a plans utilization management procedures, for the prescribed contraceptive drug, device, or product without cost sharing. Any shall defer to the determination and judgment of the attending provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider. The department shall promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an enrollee, an enrollees designee, or an enrollees provider to request coverage of an alternative prescribed contraceptive. A request by a contracting provider shall be responded to by the health care service plan in compliance with the Knox-Keene Health Care Service Plan Act of 1975, as set forth in this chapter and, as applicable, with the plans Medi-Cal managed care contract.
(3)Except as otherwise authorized under this section, a health care service plan shall not infringe upon an enrollees choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision. subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Benefits for an enrollee under this subdivision shall be the same for an enrollees covered spouse and covered nonspouse dependents.
(5)For purposes of paragraphs (2) and (3) of this subdivision, and subdivision (d), this subdivision, health care service plan shall include Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
(c)Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for FDA-approved contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a health care service plan contract shall be provided without coverage for contraceptive methods. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(1)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization as described in Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive health care services the employer refuses to cover for religious reasons.(2)If a religious employer makes an election under this section not to purchase coverage for contraceptive methods, all of the following shall apply:
(A)The religious employer shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive health care services the employer refuses to cover for religious reasons.
(B)An employee may submit a request for no-cost contraceptive care coverage to the health care service plan, drugs, devices, products, and procedures. If a request is received, the health care service plan shall provide no-cost contraceptive coverage following the requirements of this section and provisions outlined in Senate Bill No. 999 (Ch. 499, Stats. 2016).
(C)The health care service plan shall be reimbursed by the state for contraceptive care, services, drugs, devices, products, and procedures provided to employees under this provision. This subparagraph shall cease to be implemented on July 1, 2023, unless the department determines that date may be extended based on utilization demand and need, and subject to an appropriation by the Legislature for that purpose.
(D)A religious employer that invokes the exemption under this subparagraph may not discriminate, fire, or enforce other workplace punishment against an employee based on the employees decision to independently obtain contraceptive coverage, care, or prescriptions outside of the employer-based plan.
(d)(1)Every health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an enrollee by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)Nothing in this This subdivision shall not be construed to require a health care service plan contract to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the plans policies governing out-of-network coverage.
(3)Nothing in this This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health care service plan subject to this subdivision, in the absence of clinical contraindications, shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply.
(e)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within his or her the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee.
(f)This section shall not be construed to deny or restrict in any way the departments authority to ensure plan compliance with this chapter when a plan provides coverage for contraceptive drugs, devices, and products.
(g)This section shall not be construed to require an individual or group health care service plan contract to cover experimental or investigational treatments.
(h)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to health care service plan contracts issued, amended, or renewed on or after January 1, 2016, provider means an individual who is certified or licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of this code.
(i)The changes made to this section by the act that added this subdivision apply only to a health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 2022.
SEC. 5.Section 10123.196 of the Insurance Code is amended to read:10123.196.(a)An individual or group policy of disability insurance issued, amended, renewed, or delivered on or after January 1, 2000, through December 31, 2015, inclusive, that provides coverage for hospital, medical, or surgical expenses, shall provide coverage for the following, under the same terms and conditions as applicable to all benefits:
(1)A disability insurance policy that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration (FDA)-approved prescription contraceptive methods, as designated by the insurer. If an insureds health care provider determines that none of the methods designated by the disability insurer is medically appropriate for the insureds medical or personal history, the insurer shall, in the alternative, provide coverage for some other FDA-approved prescription contraceptive method prescribed by the patients health care provider.
(2)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(b)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2016, shall provide coverage for all of the following services and contraceptive methods for women: all policyholders and insureds:
(A)Except as provided in subparagraphs (B) and (C) of paragraph (2), all FDA-approved, contraceptive drugs, devices, and other products for women, products, including all FDA-approved, contraceptive drugs, devices, and products available over the counter, as prescribed by the insureds provider. counter without a prescription, as follows:
(i)A health insurer shall not require a prescription to trigger coverage of over-the-counter FDA-approved contraceptive drugs, devices, and products.
(ii)A health insurer is required to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost-sharing or medical management restrictions and reimburse insureds for out-of-pocket costs for over-the-counter birth control methods purchased at any out-of-network pharmacy in California without medical management restrictions.
(iii)A health care insurer may limit the frequency and define quantities with which the coverage required under this subparagraph is provided.
(B)Voluntary sterilization procedures.
(C)Patient education and counseling on contraception.(C)Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, ultrasound, anesthesia, patient education, and counseling.
(D)Followup services related to the drugs, devices, products, and procedures covered under this subdivision, including, but not limited to, management of side effects, counseling for continued adherence, and device insertion and removal.
(2)(A)Except for a grandfathered health plan, a A disability insurer subject to this subdivision shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision. subdivision, except for a grandfathered health plan or a qualifying health plan for a health savings account. For a qualifying health plan for a health savings account, the carrier shall establish the plans cost-sharing for the coverage required pursuant to this subdivision at the minimum level necessary to preserve the insureds ability to claim tax exempt contributions and withdrawals from the insureds health savings account under Internal Revenue Service laws and regulations.
(B)If the FDA has approved one or more therapeutic equivalents of a contraceptive drug, device, or product, a disability insurer is not required to cover all of those therapeutically equivalent versions in accordance with this subdivision, as long as at least one is covered without cost sharing in accordance with this subdivision. If there is no therapeutically equivalent generic substitute available in the market, a health care service plan is required to provide coverage without cost sharing for the original, brand name contraceptive.
(C)If a covered therapeutic equivalent of a drug, device, or product is not available, or is deemed medically inadvisable by the insureds provider, a disability insurer shall provide coverage, subject to an insurers utilization management procedures, for the prescribed contraceptive drug, device, or product without cost sharing. Any defer to the determination and judgment of the attending provider and provide coverage for the alternative prescribed contraceptive drug, device, product, or service without imposing any cost-sharing requirements. Medical inadvisability may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider. The department shall promulgate regulations establishing an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome, including timeframes, for an insured, an insureds designee or an insureds provider to request coverage of an alternative prescribed contraceptive. A request by a contracting provider shall be responded to by the disability insurer in compliance with Section 10123.191.
(3)Except as otherwise authorized under this section, an insurer shall not infringe upon an insureds choice of contraceptive drug, device, or product and shall not impose any restrictions or delays on the coverage required under this subdivision. subdivision, including prior authorization, step therapy, or other utilization control techniques.
(4)Coverage with respect to an insured under this subdivision shall be identical for an insureds covered spouse and covered nonspouse dependents.
(c)This section shall not be construed to deny or restrict in any way any existing right or benefit provided under law or by contract. The exclusion from coverage under this provision shall not apply to a contraceptive drug, device, procedure, or other product that is used for purposes other than contraception.
(d)This section shall not be construed to require an individual or group disability insurance policy to cover experimental or investigational treatments.
(e)Notwithstanding any other provision of this section, a religious employer may request a disability insurance policy without coverage for contraceptive methods that are contrary to the religious employers religious tenets. If so requested, a disability insurance policy shall be provided without coverage for contraceptive methods.
(1)For purposes of this section, a religious employer is an entity for which each of the following is true:
(A)The inculcation of religious values is the purpose of the entity.
(B)The entity primarily employs persons who share the religious tenets of the entity.
(C)The entity serves primarily persons who share the religious tenets of the entity.
(D)The entity is a nonprofit organization pursuant to Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.
(2)Every religious employer that invokes the exemption provided under this section shall provide written notice to any prospective employee once an offer of employment has been made, and prior to that person commencing that employment, listing the contraceptive health care services the employer refuses to cover for religious reasons.(2)If a religious employer makes an election under this section not to purchase coverage for contraceptive methods, all of the following shall apply:
(A)The religious employer shall provide written notice to prospective insured prior to enrollment with the plan, listing the contraceptive health care services the employer refuses to cover for religious reasons.
(B)An employee may submit a request for no-cost contraceptive care coverage to the disability insurer, drugs, devices, products, and procedures. If a request is received, the health care service plan shall provide no-cost contraceptive coverage following the requirements of this section and provisions outlined in Senate Bill No. 999 (Ch. 499, Stats. 2016).
(C)The health care service plan shall be reimbursed by the state for contraceptive care, services, drugs, devices, products, and procedures provided to employees under this provision. This subparagraph shall cease to be implemented on July 1, 2023, unless the department determines that date may be extended based on utilization demand and need, and subject to an appropriation by the Legislature for that purpose.
(D)A religious employer that invokes the exemption under this subparagraph may not discriminate, fire, or enforce other workplace punishment against an employee based on the employees decision to independently obtain contraceptive coverage, care, or prescriptions outside of the employer-based plan.
(f)(1)A group or individual policy of disability insurance, except for a specialized health insurance policy, that is issued, amended, renewed, or delivered on or after January 1, 2017, shall cover up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed or furnished at one time for an insured by a provider, pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies.
(2)Nothing in this subdivision shall This subdivision shall not be construed to require a policy to cover contraceptives provided by an out-of-network provider, pharmacy, or location licensed or otherwise authorized to dispense drugs or supplies, except as may be otherwise authorized by state or federal law or by the insurers policies governing out-of-network coverage.
(3)Nothing in this subdivision shall This subdivision shall not be construed to require a provider to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives at one time.
(4)A health insurer subject to this subdivision, in the absence of clinical contraindications, shall not impose utilization controls or other forms of medical management limiting the supply of FDA-approved, self-administered hormonal contraceptives that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies to an amount that is less than a 12-month supply.
(g)This section shall not be construed to exclude coverage for contraceptive supplies as prescribed by a provider, acting within his or her the providers scope of practice, for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an insured.
(h)This section only applies to disability insurance policies or contracts that are defined as health benefit plans pursuant to subdivision (a) of Section 10198.6, except that for accident only, specified disease, or hospital indemnity coverage, coverage for benefits under this section applies to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This section shall not be construed as imposing a new benefit mandate on accident only, specified disease, or hospital indemnity insurance.
(i)For purposes of this section, the following definitions apply:
(1)Grandfathered health plan has the meaning set forth in Section 1251 of PPACA.
(2)PPACA means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(3)With respect to policies of disability insurance issued, amended, or renewed on or after January 1, 2016, health care provider means an individual who is certified or licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or an initiative act referred to in that division, or Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
(j)The changes made to this section by the act that added this subdivision apply only to a health insurance policy that is issued, amended, renewed, or delivered on or after January 1, 2022.
SEC. 6.Section 10509.5 is added to the Public Contract Code, to read:10509.5.Notwithstanding any other law, commencing January 1, 2022, the University of California shall not approve a health benefit plan contract for employees that does not comply with the contraceptive coverage requirements of Section 1367.25 of the Health and Safety Code, Section 10123.196 of the Insurance Code, and Senate Bill No. 999 (Ch. 499, Stats. 2016).
SEC. 7.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
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Date
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Status
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|---|---|
| Sep 27, 2022 | Chaptered by Secretary of State. Chapter 630, Statutes of 2022. |
| Sep 27, 2022 | Approved by the Governor. |
| Sep 9, 2022 | Enrolled and presented to the Governor at 3 p.m. |
| Aug 31, 2022 | Assembly amendments concurred in. (Ayes 31. Noes 9. Page 5377.) Ordered to engrossing and enrolling. |
| Aug 30, 2022 | From committee: That the Assembly amendments be concurred in. (Ayes 8. Noes 2. Page 5347.) |
| Aug 30, 2022 | Re-referred to Com. on RLS pursuant to Senate Rule 29.10(d). |
| Aug 29, 2022 | In Senate. Concurrence in Assembly amendments pending. |
| Aug 29, 2022 | Read third time. Passed. Ordered to the Senate. |
| Aug 25, 2022 | Read third time and amended. |
| Aug 16, 2022 | Read second time. Ordered to third reading. |
| Aug 15, 2022 | Read second time and amended. Ordered to second reading. |
| Aug 11, 2022 | From committee: Do pass as amended. (Ayes 13. Noes 3.) (August 11). |
| Aug 26, 2021 | August 26 hearing postponed by committee. |
| Aug 19, 2021 | August 19 set for first hearing. Placed on suspense file. |
| Jul 8, 2021 | Read second time and amended. Re-referred to Com. on APPR. |
| Jul 7, 2021 | From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 2.) (July 6). |
| Jun 23, 2021 | From committee: Do pass and re-refer to Com. on HEALTH. (Ayes 5. Noes 1.) (June 22). Re-referred to Com. on HEALTH. |
| Jun 14, 2021 | Re-referred to Coms. on L. & E. and HEALTH pursuant to Assembly Rule 96. |
| Jun 10, 2021 | Referred to Coms. on HEALTH and L. & E. |
| Jun 2, 2021 | In Assembly. Read first time. Held at Desk. |
| Jun 1, 2021 | Read third time. Passed. (Ayes 32. Noes 5. Page 1332.) Ordered to the Assembly. |
| May 20, 2021 | From committee: Do pass. (Ayes 5. Noes 2. Page 1195.) (May 20). |
| May 18, 2021 | Set for hearing May 20. |
| May 17, 2021 | May 17 hearing: Placed on APPR suspense file. |
| May 7, 2021 | Set for hearing May 17. |
| May 3, 2021 | Read second time and amended. Re-referred to Com. on APPR. |
| Apr 29, 2021 | From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 8. Noes 2. Page 955.) (April 28). |
| Apr 20, 2021 | Set for hearing April 28. |
| Apr 19, 2021 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH. |
| Apr 19, 2021 | April 21 hearing postponed by committee. |
| Apr 12, 2021 | Set for hearing April 21. |
| Apr 6, 2021 | From committee: Do pass and re-refer to Com. on HEALTH. (Ayes 4. Noes 0. Page 671.) (April 5). Re-referred to Com. on HEALTH. |
| Mar 23, 2021 | Set for hearing April 5. |
| Mar 18, 2021 | Withdrawn from committee. |
| Mar 16, 2021 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH. |
| Feb 25, 2021 | Referral to Com. on JUD. rescinded because of the limitations placed on committee hearings due to ongoing health and safety risks of the COVID-19 virus. |
| Feb 25, 2021 | Referred to Coms. on HEALTH, L., P.E. & R., and JUD. |
| Feb 22, 2021 | Art. IV. Sec. 8(a) of the Constitution dispensed with. |
| Feb 18, 2021 | From printer. May be acted upon on or after March 20. |
| Feb 17, 2021 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
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Date
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Description
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Location
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Votes
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|
|---|---|---|---|---|
| Aug 31, 2022 | Unfinished Business SB523 Leyva et al. Concurrence | Senate Floor |
Passed |
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| Aug 29, 2022 | SB 523 Leyva Senate Third Reading By Cristina Garcia | Assembly Floor |
Passed |
|
| Jun 1, 2021 | Senate 3rd Reading SB523 Leyva et al. | Senate Floor |
Passed |
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Positions by individuals are not included.
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