SB 541: Sexual health: contraceptives.
- Session Year: 2023-2024
- House: Senate
- Latest Version Date: 2023-09-13
Current Status:
Failed
(2024-01-25: Veto sustained.)
Introduced
In Committee
First Chamber
In Committee
Second Chamber
Enacted
(1)Existing law, the California Healthy Youth Act, requires school districts, defined to include county boards of education, county superintendents of schools, the California School for the Deaf, the California School for the Blind, and charter schools, to ensure that all pupils in grades 7 to 12, inclusive, receive comprehensive sexual health education and human immunodeficiency virus (HIV) prevention education, as specified.
This bill would, in order to prevent and reduce unintended pregnancies and sexually transmitted infections, on or before the start of the 202425 school year, require each public school, including schools operated by a school district or county office of education, charter schools, and state special schools, to make internal and external condoms available to all pupils in grades 9 to 12, inclusive, free of charge, as provided. The bill would require these public schools to, at the beginning of each school year, inform pupils through existing school communication channels that free condoms are available and where the condoms can be obtained on school grounds. The bill would require a public school to post at least one notice regarding these requirements, as specified. The bill would require this notice to include certain information, including, among other information, information about how to use condoms properly. The bill would require each public school serving any of grades 7 to 12, inclusive, to allow condoms to be made available during the course of, or in connection with, educational or public health programs and initiatives, as provided. The bill would authorize a state agency, the State Department of Education, or a public school to accept gifts, grants, and donations from any source for the support of a public school carrying out these provisions, including, but not limited to, the acceptance of condoms from a manufacturer or wholesaler. The bill would, in order to comply with these provisions, encourage public schools to explore partnerships, including, but not limited to, partnerships with local health jurisdictions, as defined, community health centers, nonprofit organizations, and the State Department of Public Health. By imposing additional duties on public schools, the bill would impose a state-mandated local program.
The bill would additionally prohibit a public school, as defined, maintaining any combination of classrooms from grades 7 to 12, inclusive, a school district, the State Department of Education, or a county office of education from prohibiting certain school-based health centers, as defined, from making internal and external condoms available and easily accessible to pupils at the school-based health center site.
(2)Under existing law, the Sherman Food, Drug, and Cosmetic Law, the State Department of Public Health generally regulates the packaging, labeling, advertising, and sale of food, drugs, devices, and cosmetics, in accordance with the Federal Food, Drug, and Cosmetic Act. A violation of those provisions is generally a crime. Existing law sets forth various other provisions relating to the furnishing and health care coverage of certain types of contraception.
This bill would, with certain exceptions, prohibit a retail establishment, as defined, from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age. Under the bill, a violation of that prohibition would be exempt from the above-described criminal penalty.
(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, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
(1)Existing law, the California Healthy Youth Act, requires school districts, defined to include county boards of education, county superintendents of schools, the California School for the Deaf, the California School for the Blind, and charter schools, to ensure that all pupils in grades 7 to 12, inclusive, receive comprehensive sexual health education and human immunodeficiency virus (HIV) prevention education, as specified.
This bill would, in order to prevent and reduce unintended pregnancies and sexually transmitted infections, on or before the start of the 202425 school year, require each public school, including schools operated by a school district or county office of education, charter schools, and state special schools, to make internal and external condoms available to all pupils in grades 9 to 12, inclusive, free of charge, as provided. The bill would require these public schools to, at the beginning of each school year, inform pupils through existing school communication channels that free condoms are available and where the condoms can be obtained on school grounds. The bill would require a public school to post at least one notice regarding these requirements, as specified. The bill would require this notice to include certain information, including, among other information, information about how to use condoms properly. The bill would require each public school serving any of grades 7 to 12, inclusive, to allow the distribution of condoms to be made available during the course of, or in connection with, educational or public health programs and initiatives, as provided. The bill would authorize a state agency, the State Department of Education, or a public school to accept gifts, grants, and donations from any source for the support of a public school carrying out these provisions, including, but not limited to, the acceptance of condoms from a manufacturer or wholesaler. The bill would, in order to comply with these provisions, encourage public schools to explore partnerships, including, but not limited to, partnerships with local health jurisdictions, as defined, community health centers, nonprofit organizations, and the State Department of Public Health. By imposing additional duties on public schools, the bill would impose a state-mandated local program.
The bill would additionally prohibit a public school, as defined, maintaining any combination of classrooms from grades 7 to 12, inclusive, a school district, the State Department of Education, or a county office of education from prohibiting certain school-based health centers, as defined, from making internal and external condoms available and easily accessible to pupils at the school-based health center site.
(2)Under existing law, the Sherman Food, Drug, and Cosmetic Law, the State Department of Public Health generally regulates the packaging, labeling, advertising, and sale of food, drugs, devices, and cosmetics, in accordance with the Federal Food, Drug, and Cosmetic Act. A violation of those provisions is generally a crime. Existing law sets forth various other provisions relating to the furnishing and health care coverage of certain types of contraception.
This bill would, with certain exceptions, prohibit a retail establishment, as defined, from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age. Under the bill, a violation of that prohibition would be exempt from the above-described criminal penalty.
(3)Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law sets forth a schedule of benefits under the Medi-Cal program, including the Family Planning, Access, Care, and Treatment (Family PACT) Program pursuant to a federal waiver.Under existing law, the Family PACT Program provides comprehensive clinical family planning services to a person who has a family income at or below 200% of the federal poverty level and who is eligible to receive those services pursuant to the waiver.This bill would add, to the list of comprehensive clinical family planning services under the Family PACT Program, coverage for immunization against human papillomavirus (HPV), as clinically indicated, to persons who are between 12 and 18 years of age, inclusive, at Family PACT provider sites that are not enrolled in the federally funded Vaccines for Children Program that is administered by the federal Centers for Disease Control and Prevention. The bill would specify that this requirement not be construed as prohibiting the department from providing that coverage to persons who are over 18 years of age through the Family PACT Program. The bill would also make nonsubstantive changes.(4)(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, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
(1)Existing law, the California Healthy Youth Act, requires school districts, defined to include county boards of education, county superintendents of schools, the California School for the Deaf, the California School for the Blind, and charter schools, to ensure that all pupils in grades 7 to 12, inclusive, receive comprehensive sexual health education and human immunodeficiency virus (HIV) prevention education, as specified.
This bill would, in order to prevent and reduce unintended pregnancies and sexually transmitted infections, on or before the start of the 202425 school year, require each public school, including schools operated by a school district or county office of education and education, charter schools, and state special schools, to make internal and external condoms available to all pupils in grades 9 to 12, inclusive, free of charge, as provided. The bill would require these public schools to, at the beginning of each school year, inform pupils through existing school communication channels that free condoms are available and where the condoms can be obtained on school grounds. The bill would require a public school to post at least one notice regarding these requirements, as specified. The bill would require this notice to include certain information, including, among other information, information about how to use condoms properly. The bill would require each public school serving any of grades 7 to 12, inclusive, to allow the distribution of condoms during the course of, or in connection with, educational or public health programs and initiatives, as provided. The bill would authorize a state agency, the State Department of Education, or a public school to accept gifts, grants, and donations from any source for the support of a public school carrying out these provisions, including, but not limited to, the acceptance of condoms from a manufacturer or wholesaler. The bill would, in order to comply with these provisions, encourage public schools to explore partnerships, including, but not limited to, partnerships with local health jurisdictions, as defined, community health centers, nonprofit organizations, and the State Department of Public Health. By imposing additional duties on public schools, the bill would impose a state-mandated local program.
The bill would additionally prohibit a public school, as defined, maintaining any combination of classrooms from grades 7 to 12, inclusive, a school district, the State Department of Education, or a county office of education from prohibiting certain school-based health centers, as defined, from making internal and external condoms available and easily accessible to pupils at the school-based health center site.
(2)Under existing law, the Sherman Food, Drug, and Cosmetic Law, the State Department of Public Health generally regulates the packaging, labeling, advertising, and sale of food, drugs, devices, and cosmetics, in accordance with the Federal Food, Drug, and Cosmetic Act. A violation of those provisions is generally a crime. Existing law sets forth various other provisions relating to the furnishing and health care coverage of certain types of contraception.
This bill would, with certain exceptions, prohibit a retail establishment, as defined, from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age. Under the bill, a violation of that prohibition would be exempt from the above-described criminal penalty.
(3)Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law sets forth a schedule of benefits under the Medi-Cal program, including the Family Planning, Access, Care, and Treatment (Family PACT) Program pursuant to a federal waiver.
Under existing law, the Family PACT Program provides comprehensive clinical family planning services to a person who has a family income at or below 200% of the federal poverty level and who is eligible to receive those services pursuant to the waiver.
This bill would add, to the list of comprehensive clinical family planning services under the Family PACT Program, coverage for immunization against human papillomavirus (HPV), as clinically indicated, to persons who are between 12 and 18 years of age, inclusive, at Family PACT provider sites that are not enrolled in the federally funded Vaccines for Children Program that is administered by the federal Centers for Disease Control and Prevention. The bill would specify that this requirement not be construed as prohibiting the department from providing that coverage to persons who are over 18 years of age through the Family PACT Program. The bill would also make nonsubstantive changes.
(4)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, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
(1)Existing law, the California Healthy Youth Act, requires school districts, defined to include county boards of education, county superintendents of schools, the California School for the Deaf, the California School for the Blind, and charter schools, to ensure that all pupils in grades 7 to 12, inclusive, receive comprehensive sexual health education and human immunodeficiency virus (HIV) prevention education, as specified.
This bill would, in order to prevent and reduce unintended pregnancies and sexually transmitted infections, on or before the start of the 202425 school year, require each public school, including schools operated by a school district or county office of education and charter schools, to make internal and external condoms available to all pupils in grades 9 to 12, inclusive, free of charge, as provided. The bill would require these public schools to, at the beginning of each school year, inform pupils through existing school communication channels that free condoms are available and where the condoms can be obtained on school grounds. The bill would require a public school to post at least one notice regarding these requirements, as specified. The bill would require this notice to include certain information, including, among other information, information about how to use condoms properly. The bill would require each public school serving any of grades 7 to 12, inclusive, to allow the distribution of condoms during the course of, or in connection with, educational or public health programs and initiatives, as provided. The bill would authorize a state agency, the State Department of Education, or a public school to accept gifts, grants, and donations from any source for the support of a public school carrying out these provisions, including, but not limited to, the acceptance of condoms from a manufacturer or wholesaler. The bill would, in order to comply with these provisions, encourage public schools to explore partnerships, including, but not limited to, partnerships with local health jurisdictions, as defined, community health centers, nonprofit organizations, and the State Department of Public Health. By imposing additional duties on public schools, the bill would impose a state-mandated local program.
The bill would additionally prohibit a public school, as defined, maintaining any combination of classrooms from grades 7 to 12, inclusive, a school district, the State Department of Education, or a county office of education from prohibiting a school-based health center, certain school-based health centers, as defined, from making internal and external condoms available and easily accessible to pupils. pupils at the school-based health center site.
(2)Under existing law, the Sherman Food, Drug, and Cosmetic Law, the State Department of Public Health generally regulates the packaging, labeling, advertising, and sale of food, drugs, devices, and cosmetics, in accordance with the Federal Food, Drug, and Cosmetic Act. A violation of those provisions is generally a crime. Existing law sets forth various other provisions relating to the furnishing and health care coverage of certain types of contraception.
This bill would, with certain exceptions, prohibit a retail establishment, as defined, from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age. Under the bill, a violation of that prohibition would be exempt from the above-described criminal penalty.
(3)Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law sets forth a schedule of benefits under the Medi-Cal program, including the Family Planning, Access, Care, and Treatment (Family PACT) Program pursuant to a federal waiver.
Under existing law, the Family PACT Program provides comprehensive clinical family planning services to a person who has a family income at or below 200% of the federal poverty level and who is eligible to receive those services pursuant to the waiver.
This bill would add, to the list of comprehensive clinical family planning services under the Family PACT Program, coverage for immunization against human papillomavirus (HPV), as clinically indicated, to persons who are 18 years of age or younger. between 12 and 18 years of age, inclusive, at Family PACT provider sites that are not enrolled in the federally funded Vaccines for Children Program that is administered by the federal Centers for Disease Control and Prevention. The bill would specify that this requirement not be construed as prohibiting the department from providing that coverage to persons who are over 18 years of age through the Family PACT Program. The bill would also make nonsubstantive changes.
(4)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, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
(1)Existing law, the California Healthy Youth Act, requires school districts, defined to include county boards of education, county superintendents of schools, the California School for the Deaf, the California School for the Blind, and charter schools, to ensure that all pupils in grades 7 to 12, inclusive, receive comprehensive sexual health education and human immunodeficiency virus (HIV) prevention education, as specified.
This bill would, in order to prevent and reduce unintended pregnancies and sexually transmitted infections, on or before the start of the 202425 school year, require each public school, including schools operated by a school district or county office of education and charter schools, to make internal and external condoms available to all pupils in grades 9 to 12, inclusive, free of charge, as provided. The bill would require these public schools to, at the beginning of each school year, inform pupils through existing school communication channels that free condoms are available and where the condoms can be obtained on school grounds. The bill would, commencing with the 202425 school year, would require each a public school school to post at least one notice regarding these requirements in a prominent and conspicuous location on the school campus, requirements, as specified. The bill would require this notice to include certain information, including, among other information, information about how to use condoms properly. The bill would require each public school serving any of grades 7 to 12, inclusive, to allow the distribution of condoms during the course of, or in connection to, with, educational or public health programs and initiatives, as provided. The bill would authorize a state agency, the State Department of Education, or a public school to accept gifts, grants, and donations from any source for the support of a public school carrying out these provisions, including, but not limited to, the acceptance of condoms from a manufacturer or wholesaler. By imposing additional duties on public schools, the bill would impose a state-mandated local program.
The bill would provide that school-based health center sites located on school campuses maintaining any combination of classrooms from grades 7 to 12, inclusive, may not be prohibited from making internal and external condoms available and easily accessible at the school-based health center site to all pupils free of charge. additionally prohibit a public school, as defined, maintaining any combination of classrooms from grades 7 to 12, inclusive, from prohibiting a school-based health center, as defined, from making internal and external condoms available and easily accessible to pupils.
(2)Under existing law, the Sherman Food, Drug, and Cosmetic Law, the State Department of Public Health generally regulates the packaging, labeling, advertising, and sale of food, drugs, devices, and cosmetics, in accordance with the Federal Food, Drug, and Cosmetic Act. A violation of those provisions is generally a crime. Existing law sets forth various other provisions relating to the furnishing and health care coverage of certain types of contraception.
This bill would, with certain exceptions, prohibit a retail establishment, as defined, from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age. Under the bill, a violation of that prohibition would be exempt from the above-described criminal penalty.
(3)Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law sets forth a schedule of benefits under the Medi-Cal program, including the Family Planning, Access, Care, and Treatment (Family PACT) Program pursuant to a federal waiver.
Under existing law, the Family PACT Program provides comprehensive clinical family planning services to a person who has a family income at or below 200% of the federal poverty level and who is eligible to receive those services pursuant to the waiver.
This bill would add, to the list of comprehensive clinical family planning services under the Family PACT Program, coverage for immunization against human papillomavirus (HPV), as clinically indicated, to persons who are 18 years of age or younger. The bill would specify that this requirement not be construed as prohibiting the department from providing that coverage to persons who are over 18 years of age through the Family PACT Program.
(4)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, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
(1)Existing law, the California Healthy Youth Act, requires school districts, defined to include county boards of education, county superintendents of schools, the California School for the Deaf, the California School for the Blind, and charter schools, to ensure that all pupils in grades 7 to 12, inclusive, receive comprehensive sexual health education and human immunodeficiency virus (HIV) prevention education, as specified.
This bill would, in order to prevent and reduce unintended pregnancies and sexually transmitted infections, on or before the start of the 202425 school year, require each public school, including schools operated by a school district or county office of education and charter schools, to make internal and external condoms available to all pupils free of charge, as provided. The bill would require these public schools to, at the beginning of each school year, inform pupils through existing school communication channels that free condoms are available and where the condoms can be obtained on school grounds. The bill would, commencing with the 202324 202425 school year, require each public school to post at least one notice regarding these requirements in a prominent and conspicuous location on the school campus, as specified. The bill would require this notice to include certain information, including, among other information, information about how to use condoms properly. The bill would require each public school to allow the distribution of condoms during the course of, or in connection to, educational or public health programs and initiatives, as provided. By imposing additional duties on public school officials, schools, the bill would impose a state-mandated local program.
The bill would provide that school-based health center sites located on school campuses maintaining any combination of classrooms from grades 7 to 12, inclusive, may not be prohibited from making internal and external condoms available and easily accessible at the school-based health center site to all pupils free of charge.
(2)Under existing law, the Sherman Food, Drug, and Cosmetic Law, the State Department of Public Health generally regulates the packaging, labeling, advertising, and sale of food, drugs, devices, and cosmetics, in accordance with the Federal Food, Drug, and Cosmetic Act. A violation of those provisions is generally a crime. Existing law sets forth various other provisions relating to the furnishing and health care coverage of certain types of contraception.
This bill would, with certain exceptions, prohibit a retail establishment, as defined, from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age. Under the bill, a violation of that prohibition would be exempt from the above-described criminal penalty.
(3)Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law sets forth a schedule of benefits under the Medi-Cal program, including the Family Planning, Access, Care, and Treatment (Family PACT) Program pursuant to a federal waiver.
Under existing law, the Family PACT Program provides comprehensive clinical family planning services to a person who has a family income at or below 200% of the federal poverty level and who is eligible to receive those services pursuant to the waiver.
This bill would add, to the list of comprehensive clinical family planning services under the Family PACT Program, coverage for immunization against human papillomavirus (HPV), as clinically indicated, to persons who are 18 years of age or younger. The bill would specify that this requirement not be construed as prohibiting the department from providing that coverage to persons who are over 18 years of age through the Family PACT Program.
(4)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, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
(1)Existing law, the California Healthy Youth Act, requires school districts, defined to include county boards of education, county superintendents of schools, the California School for the Deaf, the California School for the Blind, and charter schools, to ensure that all pupils in grades 7 to 12, inclusive, receive comprehensive sexual health education and human immunodeficiency virus (HIV) prevention education, as specified.
This bill would, in order to prevent and reduce unintended pregnancies and sexually transmitted infections, require each public school, including schools operated by a school district or county office of education and charter schools, to make condoms available to all pupils free of charge, as provided. The bill would, commencing with the 202324 school year, require each public school to post at least one notice regarding these requirements in a prominent and conspicuous location on the school campus, as specified. The bill would require each public school to allow the distribution of condoms during the course of, or in connection to, educational or public health programs and initiatives, as provided. By imposing additional duties on public school officials, the bill would impose a state-mandated local program.
(2)Under existing law, the Sherman Food, Drug, and Cosmetic Law, the State Department of Public Health generally regulates the packaging, labeling, advertising, and sale of food, drugs, devices, and cosmetics, in accordance with the Federal Food, Drug, and Cosmetic Act. A violation of those provisions is generally a crime. Existing law sets forth various other provisions relating to the furnishing and health care coverage of certain types of contraception.
This bill would, with certain exceptions, prohibit a retail establishment, as defined, from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age. Under the bill, a violation of that prohibition would be exempt from the above-described criminal penalty.
(3)Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law sets forth a schedule of benefits under the Medi-Cal program, including the Family Planning, Access, Care, and Treatment (Family PACT) Program pursuant to a federal waiver.
Under existing law, the Family PACT Program provides comprehensive clinical family planning services to a person who has a family income at or below 200% of the federal poverty level and who is eligible to receive those services pursuant to the waiver.
This bill would add, to the list of comprehensive clinical family planning services under the Family PACT Program, coverage for immunization against human papillomavirus (HPV), as clinically indicated, to persons who are 18 years of age or younger. The bill would specify that this requirement not be construed as prohibiting the department from providing that coverage to persons who are over 18 years of age through the Family PACT Program.
(4)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, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
(a)The Legislature finds and declares all of the following:
(1)The federal Centers for Disease Control and Prevention (CDC) estimates that one in five people in the United States have a sexually transmitted infection (STI). More than 325,000 Californians were infected with syphilis, chlamydia, or gonorrhea in 2019.
(2)California youth, and in particular youth of color, are disproportionately impacted by the STI crisis. Statewide data indicate over one-half of all STIs in the state are experienced among California youth 15 to 24 years of age, inclusive. Young people in this age group make up more than 5 out of every 10 chlamydia cases in California, and more than 87 percent are youth of color.
(3)Most STIs go undetected and can lead to serious, life-threatening health problems later in life, including permanent tissue damage, blindness, infertility, and cancer related to HPV infections. STIs also increase both the transmission and acquisition of HIV. Approximately $1,000,000,000 is spent annually in California on health costs associated with STIs.
(4)Condoms are an effective tool to reduce STI transmission, but condom use among sexually active teens has declined over the last decade. The CDCs Youth Risk Behavior Surveillance System (YRBSS) shows that in 2019, an average of 20 percent of California high school pupils were sexually active and 47 percent of those pupils did not use condoms during their last sexual intercourse.
(5)Teens face multiple barriers to accessing condoms that deter them from seeking and securing the resources they need to protect themselves against STIs and unintended pregnancy. Through Essential Access Healths TeenSource Condom Access Project, young people reported that cost is the biggest obstacle to obtaining condoms. When cost barriers remain, youth with low incomes are often left without the option to regularly use condoms to help protect their health and prevent an unintended pregnancy from occurring.
(6)Though most health plans, including Medi-Cal, will be required to cover condoms as a no-cost over-the-counter benefit beginning in 2024, this benefit will only be extended to women. Young males will not be able to access condoms over the counter for free using their health coverage, and uninsured individuals will have to continue to pay out of pocket.
(7)Teens have also long reported experiencing difficulties while attempting to purchase condoms at some pharmacies and retailers, including being judged, shamed, or harassed, or being asked to show an identification card despite the fact that there are no age requirements for condom purchases.
(8)Condom availability programs in schools began in the early 1990s, and are a key and cost-effective strategy for helping to prevent HIV, STIs, and pregnancy among teens. According to the CDC, only 7.2 percent of high schools and 2.3 percent of middle schools made condoms available to pupils in 2014. Studies conducted by the CDC also found that condom access programs in schools did not increase sexual activity among teens and can increase condom use among sexually active pupils and pupils at high risk.
(9)In 2020, Vermont became the first state in the country to require public secondary schools to make free condoms readily available to pupils. The Society for Adolescent Health and Medicine strongly supports access to free condoms in schools in easily accessible locations, such as school-based health centers and clinics, nurses offices, and bathrooms.
(10)California has an interest in promoting and expanding equitable access to tools and resources that empower youth to make healthier choices and reduce the spread of STIs.
(b)Therefore, it is the intent of the Legislature to improve public health outcomes and reduce STI rates among California youth by making condoms more accessible for young people.
SEC. 2.Section 35292.7 is added to the Education Code, to read:35292.7.(a)In order to prevent and reduce unintended pregnancies and sexually transmitted infections, on or before the start of the 202425 school year, each public school shall make internal and external condoms available to all pupils in grades 9 to 12, inclusive, free of charge. Each public school shall make condoms available by placing condoms in a minimum of two locations on school grounds where the condoms are easily accessible to pupils during school hours without requiring assistance or permission from school staff.
(b)A public school described in subdivision (a) shall, at the beginning of each school year, inform pupils through existing school communication channels that free condoms are available and where the condoms can be obtained on school grounds.
(c)(1)A public school, as described in subdivision (a), shall post at least one notice regarding the requirements of this section and shall prominently and conspicuously display the notice on the school campus in appropriate areas that are accessible to, and commonly frequented by, pupils. This notice shall include all of the following:
(A)The contact information, including an email address and telephone number, for a designated individual responsible for maintaining the requisite supply of condoms.
(B)Information that abstinence from sexual activity and injection drug use is the only certain way to prevent HIV and other sexually transmitted infections and that abstinence from sexual intercourse is the only certain way to prevent unintended pregnancy.
(C)Information directing pupils where they can find information about how to use condoms properly.
(D)Information on how to access local resources and pupils legal rights to access local resources for sexual and reproductive health care such as testing and medical care for HIV and other sexually transmitted infections and pregnancy prevention and care, as well as local resources for assistance with sexual assault and intimate partner violence.
(2)A public school shall, upon request, provide the notice described in paragraph (1) in an accessible format to ensure all pupils, including, but not limited to, those with visual disabilities, are able to access the notice.
(d)Each public school serving any of grades 7 to 12, inclusive, shall allow condoms to be made available during the course of, or in connection with, educational or public health programs and initiatives, including, but not limited to, from any of the following:
(1)Community organizations or other entities providing instruction for purposes of the California Healthy Youth Act (Chapter 5.6 (commencing with Section 51930) of Part 28 of Division 4).
(2)Pupil peer health programs, clubs, or groups.
(3)Pupil health fairs conducted on campus.
(4)School-based health center staff.
(e)(1)A state agency, the department, or a public school may accept gifts, grants, and donations from any source for the support of a public school carrying out the provisions of this section, including, but not limited to, the acceptance of condoms from a manufacturer or wholesaler.
(2)In order to comply with the provisions of this section, public schools are encouraged to explore partnerships, including, but not limited to, partnerships with local health jurisdictions, community health centers, nonprofit organizations, and the State Department of Public Health.
(f)For purposes of this section, the following terms have the following meanings:
(1)Local health jurisdiction has the same meaning as subdivision (f) of Section 124030 of the Health and Safety Code.
(2)Public school includes a school operated by a school district, a school operated by a county office of education, a charter school, and a state special school.
SEC. 3.Article 16 (commencing with Section 49595) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code , to read:16.Miscellaneous Provisions49595.(a)A public school maintaining any combination of classrooms from grades 7 to 12, inclusive, a school district, the department, or a county office of education shall not prohibit a school-based health center that serves a public school serving any of grades 7 to 12, inclusive, from making internal and external condoms available and easily accessible to pupils at the school-based health center site.
(b)For purposes of this section, the following definitions apply:
(1)Public school includes a school operated by a school district, a school operated by a county office of education, and a charter school.
(2)(A)School-based health center means a center or program, located at or near a public school, that provides age-appropriate health care services at the program site or through referrals.
(B)A school-based health center includes a center or program described in subparagraph (A) that may conduct routine physical, mental health, and oral health assessments, and provide referrals for any services not offered onsite.
(C)A school-based health center includes a center or program described in subparagraph (A) that may serve two or more nonadjacent schools or local educational agencies.
SEC. 4.Chapter 7.7 (commencing with Section 111823) is added to Part 5 of Division 104 of the Health and Safety Code, to read:7.7.Nonprescription Contraception111823.(a)A retail establishment shall not refuse to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age.
(b)Section 111825 does not apply to a violation of subdivision (a).
(c)Subdivision (a) does not apply to the refusal to furnish nonprescription contraception on the basis of age if, under other provisions of federal or state law, the contraception is subject to restrictions on the basis of age.
(d)For purposes of this section, retail establishment means any vendor that, in the regular course of business, furnishes nonprescription contraception at retail directly to the public, including, but not limited to, a pharmacy, grocery store, or other retail store.
SEC. 5.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)The Legislature finds and declares all of the following:
(1)The federal Centers for Disease Control and Prevention (CDC) estimates that one in five people in the United States have a sexually transmitted infection (STI). More than 325,000 Californians were infected with syphilis, chlamydia, or gonorrhea in 2019.
(2)California youth, and in particular youth of color, are disproportionately impacted by the STI crisis. Statewide data indicate over one-half of all STIs in the state are experienced among California youth 15 to 24 years of age, inclusive. Young people in this age group make up more than 5 out of every 10 chlamydia cases in California, and more than 87 percent are youth of color.
(3)Untreated STIs can lead to serious long-term health consequences. The CDC estimates that untreated STIs cause at least 24,000 women in the United States each year to become infertile. The human papillomavirus (HPV) can lead to increased risk of developing cancer. The number of HPV-related cancers in men dramatically increased in 2016.(4)Vaccination rates against HPV are down nationwide due to the COVID-19 pandemic, putting teens and young people at risk of developing HPV-related cancers later in life. While nearly 80 percent of California teens received the first of three doses of the HPV vaccine in 2020, the vast majority do not complete the full vaccination series, leaving them without maximum protection.(3)Most STIs go undetected and can lead to serious, life-threatening health problems later in life, including permanent tissue damage, blindness, infertility, and cancer related to HPV infections. STIs also increase both the transmission and acquisition of HIV. Approximately $1,000,000,000 is spent annually in California on health costs associated with STIs.
(5)(4)Condoms are an effective tool to reduce STI transmission, but condom use among sexually active teens has declined over the last decade. The CDCs Youth Risk Behavior Surveillance System (YRBSS) shows that in 2019, an average of 20 percent of California high school pupils were sexually active and 47 percent of those pupils did not use condoms during their last sexual intercourse.
(6)(5)Teens face multiple barriers to accessing condoms that deter them from seeking and securing the resources they need to protect themselves against STIs and unintended pregnancy. Through Essential Access Healths TeenSource Condom Access Project, young people reported that cost is the biggest obstacle to obtaining condoms. When cost barriers remain, youth with low incomes are often left without the option to regularly use condoms to help protect their health and prevent an unintended pregnancy from occurring.
(7)(6)Though most health plans, including Medi-Cal, will be required to cover condoms as a no-cost over-the-counter benefit beginning in 2024, this benefit will only be extended to women. Young males will not be able to access condoms over the counter for free using their health coverage, and uninsured individuals will have to continue to pay out of pocket.
(8)(7)Teens have also long reported experiencing difficulties while attempting to purchase condoms at some pharmacies and retailers, including being judged, shamed, or harassed, or being asked to show an identification card despite the fact that there are no age requirements for condom purchases.
(9)(8)Condom availability programs in schools began in the early 1990s, and are a key and cost-effective strategy for helping to prevent HIV, STIs, and pregnancy among teens. According to the CDC, only 7.2 percent of high schools and 2.3 percent of middle schools made condoms available to pupils in 2014. Studies conducted by the CDC also found that condom access programs in schools did not increase sexual activity among teens and can increase condom use among sexually active pupils and pupils at high risk.
(10)(9)In 2020, Vermont became the first state in the country to require public secondary schools to make free condoms readily available to pupils. The Society for Adolescent Health and Medicine strongly supports access to free condoms in schools in easily accessible locations, such as school-based health centers and clinics, nurses offices, and bathrooms.
(11)(10)California has an interest in promoting and expanding equitable access to tools and resources that empower youth to make healthier choices and reduce the spread of STIs.
(b)Therefore, it is the intent of the Legislature to improve public health outcomes and reduce STI rates among California youth by making condoms more accessible for young people and ensuring there is no wrong door for HPV vaccine access. people.
SEC. 2.Section 35292.7 is added to the Education Code, to read:35292.7.(a)In order to prevent and reduce unintended pregnancies and sexually transmitted infections, on or before the start of the 202425 school year, each public school shall make internal and external condoms available to all pupils in grades 9 to 12, inclusive, free of charge. Each public school shall distribute condoms in the following manner:
(1)Condoms shall be placed shall make condoms available by placing condoms in a minimum of two locations on school grounds where the condoms are easily accessible to pupils during school hours without requiring assistance or permission from school staff.
(2)Condoms placed in locations not regularly supervised by school staff shall be stored in tamper-proof dispensers.(b)A public school described in subdivision (a) shall, at the beginning of each school year, inform pupils through existing school communication channels that free condoms are available and where the condoms can be obtained on school grounds.
(c)(1)A public school, as described in subdivision (a), shall post at least one notice regarding the requirements of this section and shall prominently and conspicuously display the notice on the school campus in appropriate areas that are accessible to, and commonly frequented by, pupils. This notice shall include all of the following:
(1)(A)The contact information, including an email address and telephone number, for a designated individual responsible for maintaining the requisite supply of condoms.
(2)(B)Information that abstinence from sexual activity and injection drug use is the only certain way to prevent HIV and other sexually transmitted infections and that abstinence from sexual intercourse is the only certain way to prevent unintended pregnancy.
(3)(C)Information directing pupils where they can find information about how to use condoms properly.
(4)(D)Information on how to access local resources and pupils legal rights to access local resources for sexual and reproductive health care such as testing and medical care for HIV and other sexually transmitted infections and pregnancy prevention and care, as well as local resources for assistance with sexual assault and intimate partner violence.
(2)A public school shall, upon request, provide the notice described in paragraph (1) in an accessible format to ensure all pupils, including, but not limited to, those with visual disabilities, are able to access the notice.
(d)Each public school serving any of grades 7 to 12, inclusive, shall allow the distribution of condoms to be made available during the course of, or in connection with, educational or public health programs and initiatives, including, but not limited to, from any of the following:
(1)Community organizations or other entities providing instruction for purposes of the California Healthy Youth Act (Chapter 5.6 (commencing with Section 51930) of Part 28 of Division 4).
(2)Pupil peer health programs, clubs, or groups.
(3)Pupil health fairs conducted on campus.
(4)School-based health center staff.
(e)(1)A state agency, the department, or a public school may accept gifts, grants, and donations from any source for the support of a public school carrying out the provisions of this section, including, but not limited to, the acceptance of condoms from a manufacturer or wholesaler.
(2)In order to comply with the provisions of this section, public schools are encouraged to explore partnerships, including, but not limited to, partnerships with local health jurisdictions, community health centers, nonprofit organizations, and the State Department of Public Health.
(f)For purposes of this section, the following terms have the following meanings:
(1)Local health jurisdiction has the same meaning as subdivision (f) of Section 124030 of the Health and Safety Code.
(2)Public school includes a school operated by a school district, a school operated by a county office of education, a charter school, and a state special school.
SEC. 3.Article 15 (commencing with Section 49595) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, to read:15.Miscellaneous ProvisionsSEC. 3.Article 16 (commencing with Section 49595) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code , to read:16.Miscellaneous Provisions49595.(a)A public school maintaining any combination of classrooms from grades 7 to 12, inclusive, a school district, the department, or a county office of education shall not prohibit a school-based health center that serves a public school serving any of grades 7 to 12, inclusive, from making internal and external condoms available and easily accessible to pupils at the school-based health center site.
(b)For purposes of this section, the following definitions apply:
(1)Public school includes a school operated by a school district, a school operated by a county office of education, and a charter school.
(2)(A)School-based health center means a center or program, located at or near a public school, that provides age-appropriate health care services at the program site or through referrals.
(B)A school-based health center includes a center or program described in subparagraph (A) that may conduct routine physical, mental health, and oral health assessments, and provide referrals for any services not offered onsite.
(C)A school-based health center includes a center or program described in subparagraph (A) that may serve two or more nonadjacent schools or local educational agencies.
SEC. 4.Chapter 7.7 (commencing with Section 111823) is added to Part 5 of Division 104 of the Health and Safety Code, to read:7.7.Nonprescription Contraception111823.(a)A retail establishment shall not refuse to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age.
(b)Section 111825 does not apply to a violation of subdivision (a).
(c)Subdivision (a) does not apply to the refusal to furnish nonprescription contraception on the basis of age if, under other provisions of federal or state law, the contraception is subject to restrictions on the basis of age.
(d)For purposes of this section, retail establishment means any vendor that, in the regular course of business, furnishes nonprescription contraception at retail directly to the public, including, but not limited to, a pharmacy, grocery store, or other retail store.
SEC. 5.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 Contract Drugs List 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 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 immunodeficiency 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 federal 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.(H)Coverage for immunization against human papillomavirus (HPV), as clinically indicated, to persons who are between 12 and 18 years of age, inclusive, at Family PACT provider sites that are not enrolled in the federally funded Vaccines for Children Program that is administered by the federal Centers for Disease Control and Prevention. This subparagraph shall not be construed as prohibiting the department from providing that coverage to persons who are over 18 years of age through the Family PACT Program.(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 federal 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.(ag)(1)Violence prevention services are covered, subject to medical necessity and utilization controls.(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, may 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.(4)The department shall post on its internet website the date upon which violence prevention services may be provided and billed pursuant to this subdivision.(5)Violence prevention services means evidence-based, trauma-informed, and culturally responsive preventive services provided to reduce the incidence of violent injury or reinjury, trauma, and related harms and promote trauma recovery, stabilization, and improved health outcomes.SEC. 6.SEC. 5.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)The Legislature finds and declares all of the following:
(1)The federal Centers for Disease Control and Prevention (CDC) estimates that one in five people in the United States have a sexually transmitted infection (STI). More than 325,000 Californians were infected with syphilis, chlamydia, or gonorrhea in 2019.
(2)California youth, and in particular youth of color, are disproportionately impacted by the STI crisis. Statewide data indicate over one-half of all STIs in the state are experienced among California youth 15 to 24 years of age, inclusive. Young people in this age group make up more than 5 out of every 10 chlamydia cases in California, and more than 87 percent are youth of color.
(3)Untreated STIs can lead to serious long-term health consequences. The CDC estimates that untreated STIs cause at least 24,000 women in the United States each year to become infertile. The human papillomavirus (HPV) can lead to increased risk of developing cancer. The number of HPV-related cancers in men dramatically increased in 2016.
(4)Vaccination rates against HPV are down nationwide due to the COVID-19 pandemic, putting teens and young people at risk of developing HPV-related cancers later in life. While nearly 80 percent of California teens received the first of three doses of the HPV vaccine in 2020, the vast majority do not complete the full vaccination series, leaving them without maximum protection.
(5)Condoms are an effective tool to reduce STI transmission, but condom use among sexually active teens has declined over the last decade. The CDCs Youth Risk Behavior Surveillance System (YRBSS) shows that in 2019, an average of 20 percent of California high school pupils were sexually active and 47 percent of those pupils did not use condoms during their last sexual intercourse.
(6)Teens face multiple barriers to accessing condoms that deter them from seeking and securing the resources they need to protect themselves against STIs and unintended pregnancy. Through Essential Access Healths TeenSource Condom Access Project, young people reported that cost is the biggest obstacle to obtaining condoms. When cost barriers remain, youth with low incomes are often left without the option to regularly use condoms to help protect their health and prevent an unintended pregnancy from occurring.
(7)Though most health plans, including Medi-Cal, will be required to cover condoms as a no-cost over-the-counter benefit beginning in 2024, this benefit will only be extended to women. Young males will not be able to access condoms over the counter for free using their health coverage, and uninsured individuals will have to continue to pay out of pocket.
(8)Teens have also long reported experiencing difficulties while attempting to purchase condoms at some pharmacies and retailers, including being judged, shamed, or harassed, or being asked to show an identification card despite the fact that there are no age requirements for condom purchases.
(9)Condom availability programs in schools began in the early 1990s, and are a key and cost-effective strategy for helping to prevent HIV, STIs, and pregnancy among teens. According to the CDC, only 7.2 percent of high schools and 2.3 percent of middle schools made condoms available to pupils in 2014. Studies conducted by the CDC also found that condom access programs in schools did not increase sexual activity among teens and can increase condom use among sexually active pupils and pupils at high risk.
(10)In 2020, Vermont became the first state in the country to require public secondary schools to make free condoms readily available to pupils. The Society for Adolescent Health and Medicine strongly supports access to free condoms in schools in easily accessible locations, such as school-based health centers and clinics, nurses offices, and bathrooms.
(11)California has an interest in promoting and expanding equitable access to tools and resources that empower youth to make healthier choices and reduce the spread of STIs.
(b)Therefore, it is the intent of the Legislature to improve public health outcomes and reduce STI rates among California youth by making condoms more accessible for young people and ensuring there is no wrong door for HPV vaccine access.
SEC. 2.Section 35292.7 is added to the Education Code, to read:35292.7.(a)In order to prevent and reduce unintended pregnancies and sexually transmitted infections, on or before the start of the 202425 school year, each public school shall make internal and external condoms available to all pupils in grades 9 to 12, inclusive, free of charge. Each public school shall distribute condoms in the following manner:
(1)Condoms shall be placed in a minimum of two locations on school grounds where the condoms are easily accessible to pupils during school hours without requiring assistance or permission from school staff.
(2)Condoms placed in locations not regularly supervised by school staff shall be stored in tamper-proof dispensers.
(b)A public school described in subdivision (a) shall, at the beginning of each school year, inform pupils through existing school communication channels that free condoms are available and where the condoms can be obtained on school grounds.
(c)A public school, as described in subdivision (a), shall post at least one notice regarding the requirements of this section and shall prominently and conspicuously display the notice on the school campus in appropriate areas that are accessible to, and commonly frequented by, pupils. This notice shall include all of the following:
(1)The text of this section.(2)(1)The contact information, including an email address and telephone number, for a designated individual responsible for maintaining the requisite supply of condoms.
(3)(2)Information that abstinence from sexual activity and injection drug use is the only certain way to prevent HIV and other sexually transmitted infections and that abstinence from sexual intercourse is the only certain way to prevent unintended pregnancy.
(4)(3)Information directing pupils where they can find information about how to use condoms properly.
(5)(4)Information on how to access local resources and pupils legal rights to access local resources for sexual and reproductive health care such as testing and medical care for HIV and other sexually transmitted infections and pregnancy prevention and care, as well as local resources for assistance with sexual assault and intimate partner violence.
(d)Each public school serving any of grades 7 to 12, inclusive, shall allow the distribution of condoms during the course of, or in connection with, educational or public health programs and initiatives, including, but not limited to, from any of the following:
(1)Community organizations or other entities providing instruction for purposes of the California Healthy Youth Act (Chapter 5.6 (commencing with Section 51930) of Part 28 of Division 4).
(2)Pupil peer health programs, clubs, or groups.
(3)Pupil health fairs conducted on campus.
(4)School-based health center staff.
(e)(1)A state agency, the department, or a public school may accept gifts, grants, and donations from any source for the support of a public school carrying out the provisions of this section, including, but not limited to, the acceptance of condoms from a manufacturer or wholesaler.
(2)In order to comply with the provisions of this section, public schools are encouraged to explore partnerships, including, but not limited to, partnerships with local health jurisdictions, community health centers, nonprofit organizations, and the State Department of Public Health.
(f)For purposes of this section, the following terms have the following meanings:
(1)Local health jurisdiction has the same meaning as subdivision (f) of Section 124030 of the Health and Safety Code.
(2)Public school includes a school operated by a school district, a school operated by a county office of education, and education, a charter school. school, and a state special school.
SEC. 3.Article 15 (commencing with Section 49595) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, to read:15.Miscellaneous Provisions49595.(a)A public school maintaining any combination of classrooms from grades 7 to 12, inclusive, a school district, the department, or a county office of education shall not prohibit a school-based health center that serves a public school serving any of grades 7 to 12, inclusive, from making internal and external condoms available and easily accessible to pupils at the school-based health center site.
(b)For purposes of this section, the following definitions apply:
(1)Public school includes a school operated by a school district, a school operated by a county office of education, and a charter school.
(2)(A)School-based health center means a center or program, located at or near a public school, that provides age-appropriate health care services at the program site or through referrals.
(B)A school-based health center includes a center or program described in subparagraph (A) that may conduct routine physical, mental health, and oral health assessments, and provide referrals for any services not offered onsite.
(C)A school-based health center includes a center or program described in subparagraph (A) that may serve two or more nonadjacent schools or local educational agencies.
SEC. 4.Chapter 7.7 (commencing with Section 111823) is added to Part 5 of Division 104 of the Health and Safety Code, to read:7.7.Nonprescription Contraception111823.(a)A retail establishment shall not refuse to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age.
(b)Section 111825 does not apply to a violation of subdivision (a).
(c)Subdivision (a) does not apply to the refusal to furnish nonprescription contraception on the basis of age if, under other provisions of federal or state law, the contraception is subject to restrictions on the basis of age.
(d)For purposes of this section, retail establishment means any vendor that, in the regular course of business, furnishes nonprescription contraception at retail directly to the public, including, but not limited to, a pharmacy, grocery store, or other retail store.
SEC. 5.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 Contract Drugs List 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 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 immunodeficiency 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 federal 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.
(H)Coverage for immunization against human papillomavirus (HPV), as clinically indicated, to persons who are between 12 and 18 years of age, inclusive, at Family PACT provider sites that are not enrolled in the federally funded Vaccines for Children Program that is administered by the federal Centers for Disease Control and Prevention. This subparagraph shall not be construed as prohibiting the department from providing that coverage to persons who are over 18 years of age through the Family PACT Program.
(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 federal 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.
(ag)(1)Violence prevention services are covered, subject to medical necessity and utilization controls.
(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, may 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.
(4)The department shall post on its internet website the date upon which violence prevention services may be provided and billed pursuant to this subdivision.
(5)Violence prevention services means evidence-based, trauma-informed, and culturally responsive preventive services provided to reduce the incidence of violent injury or reinjury, trauma, and related harms and promote trauma recovery, stabilization, and improved health outcomes.
SEC. 6.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)The Legislature finds and declares all of the following:
(1)The federal Centers for Disease Control and Prevention (CDC) estimates that one in five people in the United States have a sexually transmitted infection (STI). More than 325,000 Californians were infected with syphilis, chlamydia, or gonorrhea in 2019.
(2)California youth, and in particular youth of color, are disproportionately impacted by the STI crisis. Statewide data indicate over half one-half of all STIs in the state are experienced among California youth 15 to 24 years of age, inclusive. Young people in this age group make up more than 5 out of every 10 chlamydia cases in California, and more than 87 percent are youth of color.
(3)Untreated STIs can lead to serious long-term health consequences. The CDC estimates that untreated STIs cause at least 24,000 women in the United States each year to become infertile. The human papillomavirus (HPV) can lead to increased risk of developing cancer. The number of HPV-related cancers in men dramatically increased in 2016.
(4)Vaccination rates against HPV are down nationwide due to the COVID-19 pandemic, putting teens and young people at risk of developing HPV-related cancers later in life. While nearly 80 percent of California teens received the first of three doses of the HPV vaccine in 2020, the vast majority do not complete the full vaccination series, leaving them without maximum protection.
(5)Condoms are an effective tool to reduce STI transmission, but condom use among sexually active teens has declined over the last decade. The CDCs Youth Risk Behavior Surveillance System (YRBSS) shows that in 2019, an average of 20 percent of California high school pupils were sexually active and 47 percent of those pupils did not use condoms during their last sexual intercourse.
(6)Teens face multiple barriers to accessing condoms that deter them from seeking and securing the resources they need to protect themselves against STIs and unintended pregnancy. Through Essential Access Healths TeenSource Condom Access Project, young people reported that cost is the biggest obstacle to obtaining condoms. When cost barriers remain, youth with low incomes are often left without the option to regularly use condoms to help protect their health and prevent an unintended pregnancy from occurring.
(7)Though most health plans, including Medi-Cal, will be required to cover condoms as a no-cost over-the-counter benefit beginning in 2024, this benefit will only be extended to women. Young males will not be able to access condoms over the counter for free using their health coverage, and uninsured individuals will have to continue to pay out of pocket.
(8)Teens have also long reported experiencing difficulties while attempting to purchase condoms at some pharmacies and retailers, including being judged, shamed, or harassed, or being asked to show an identification card despite the fact that there are no age requirements for condom purchases.
(9)Condom availability programs in schools began in the early 1990s, and are a key and cost-effective strategy for helping to prevent HIV, STIs, and pregnancy among teens. According to the CDC, only 7.2 percent of high schools and 2.3 percent of middle schools made condoms available to pupils in 2014. Studies conducted by the CDC also found that condom access programs in schools did not increase sexual activity among teens and can increase condom use among sexually active pupils and pupils at high risk.
(10)In 2020, Vermont became the first state in the country to require public secondary schools to make free condoms readily available to pupils. The Society for Adolescent Health and Medicine strongly supports access to free condoms in schools in easily accessible locations, such as school-based health centers and clinics, nurses offices, and bathrooms.
(11)California has an interest in promoting and expanding equitable access to tools and resources that empower youth to make healthier choices and reduce the spread of STIs.
(b)Therefore, it is the intent of the Legislature to improve public health outcomes and reduce STI rates among California youth by making condoms more accessible for young people and ensuring there is no wrong door for HPV vaccine access.
SEC. 2.Section 35292.7 is added to the Education Code, to read:35292.7.(a)In order to prevent and reduce unintended pregnancies and sexually transmitted infections, on or before the start of the 202425 school year, each public school shall make internal and external condoms available to all pupils in grades 9 to 12, inclusive, free of charge. Each public school shall distribute condoms in the following manner:
(1)Condoms shall be placed in a minimum of two locations on school grounds where the condoms are easily accessible to pupils during school hours without requiring assistance or permission from school staff.
(2)Condoms placed in unsupervised locations not regularly supervised by school staff shall be stored in tamper-proof dispensers.
(b)A public school described in subdivision (a) shall, at the beginning of each school year, inform pupils through existing school communication channels that free condoms are available and where the condoms can be obtained on school grounds.
(c)A public school, as described in subdivision (a), shall post at least one notice regarding the requirements of this section and shall prominently and conspicuously display the notice on the school campus in appropriate areas that are accessible to, and commonly frequented by, pupils. This notice shall include all of the following:
(1)The text of this section.
(2)The contact information, including an email address and telephone number, for a designated individual responsible for maintaining the requisite supply of condoms.
(3)Information that abstinence from sexual activity and injection drug use is the only certain way to prevent HIV and other sexually transmitted infections and that abstinence from sexual intercourse is the only certain way to prevent unintended pregnancy.
(4)Information directing pupils where they can find information about how to use condoms properly.
(5)Information on how to access local resources and pupils legal rights to access local resources for sexual and reproductive health care such as testing and medical care for HIV and other sexually transmitted infections and pregnancy prevention and care, as well as local resources for assistance with sexual assault and intimate partner violence.
(d)Each public school serving any of grades 7 to 12, inclusive, shall allow the distribution of condoms during the course of, or in connection with, educational or public health programs and initiatives, including, but not limited to, from any of the following:
(1)Community organizations or other entities providing instruction for purposes of the California Healthy Youth Act (Chapter 5.6 (commencing with Section 51930) of Part 28 of Division 4).
(2)Pupil peer health programs, clubs, or groups.
(3)Pupil health fairs conducted on campus.
(4)School-based health center staff.
(e)(1)A state agency, the department, or a public school may accept gifts, grants, and donations from any source for the support of a public school carrying out the provisions of this section, including, but not limited to, the acceptance of condoms from a manufacturer or wholesaler.
(2)In order to comply with the provisions of this section, public schools are encouraged to explore partnerships, including, but not limited to, partnerships with local health jurisdictions, community health centers, nonprofit organizations, and the State Department of Public Health.
(f)For purposes of this section, public school includes a school operated by a school district, a school operated by a county office of education, and a charter school. the following terms have the following meanings:
(1)Local health jurisdiction has the same meaning as subdivision (f) of Section 124030 of the Health and Safety Code.
(2)Public school includes a school operated by a school district, a school operated by a county office of education, and a charter school.
SEC. 3.Article 15 (commencing with Section 49595) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, to read:15.Miscellaneous Provisions49595.(a)A public school maintaining any combination of classrooms from grades 7 to 12, inclusive, a school district, the department, or a county office of education shall not prohibit a school-based health center that serves a public school serving any of grades 7 to 12, inclusive, from making internal and external condoms available and easily accessible to pupils. pupils at the school-based health center site.
(b)For purposes of this section, the following definitions apply:
(1)Public school includes a school operated by a school district, a school operated by a county office of education, and a charter school.
(2)(A)School-based health center means a center or program, located at or near a public school, that provides age-appropriate health care services at the program site or through referrals.
(B)A school-based health center includes a center or program described in subparagraph (A) that may conduct routine physical, mental health, and oral health assessments, and provide referrals for any services not offered onsite.
(C)A school-based health center includes a center or program described in subparagraph (A) that may serve two or more nonadjacent schools or local educational agencies.
SEC. 4.Chapter 7.7 (commencing with Section 111823) is added to Part 5 of Division 104 of the Health and Safety Code, to read:7.7.Nonprescription Contraception111823.(a)A retail establishment shall not refuse to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age.
(b)Section 111825 does not apply to a violation of subdivision (a).
(c)Subdivision (a) does not apply to the refusal to furnish nonprescription contraception on the basis of age if, under other provisions of federal or state law, the contraception is subject to restrictions on the basis of age.
(d)For purposes of this section, retail establishment means any vendor that, in the regular course of business, furnishes nonprescription contraception at retail directly to the public, including, but not limited to, a pharmacy, grocery store, or other retail store.
SEC. 5.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 Contract Drugs List 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 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 acquired immunodeficiency 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 federal 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.
(H)Coverage for immunization against human papillomavirus (HPV), as clinically indicated, to persons who are 18 years of age or younger. between 12 and 18 years of age, inclusive, at Family PACT provider sites that are not enrolled in the federally funded Vaccines for Children Program that is administered by the federal Centers for Disease Control and Prevention. This subparagraph shall not be construed as prohibiting the department from providing that coverage to persons who are over 18 years of age through the Family PACT Program.
(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 federal 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.
(ag)(1)Violence prevention services are covered, subject to medical necessity and utilization controls.
(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, may 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.
(4)The department shall post on its internet website the date upon which violence prevention services may be provided and billed pursuant to this subdivision.
(5)Violence prevention services means evidence-based, trauma-informed, and culturally responsive preventive services provided to reduce the incidence of violent injury or reinjury, trauma, and related harms and promote trauma recovery, stabilization, and improved health outcomes.
SEC. 6.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)The Legislature finds and declares all of the following:
(1)The federal Centers for Disease Control and Prevention (CDC) estimates that one in five people in the United States have a sexually transmitted infection (STI). More than 325,000 Californians were infected with syphilis, chlamydia, or gonorrhea in 2019.
(2)California youth, and in particular youth of color, are disproportionately impacted by the STI crisis. Statewide data indicate over half of all STIs in the state are experienced among California youth 15 to 24 years of age, inclusive. Young people in this age group make up more than 5 out of every 10 chlamydia cases in California, and more than 87 percent are youth of color.
(3)Untreated STIs can lead to serious long-term health consequences. The CDC estimates that untreated STIs cause at least 24,000 women in the United States each year to become infertile. The human papillomavirus (HPV) can lead to increased risk of developing cancer. The number of HPV-related cancers in men dramatically increased in 2016.
(4)Vaccination rates against HPV are down nationwide due to the COVID-19 pandemic, putting teens and young people at risk of developing HPV-related cancers later in life. While nearly 80 percent of California teens received the first of three doses of the HPV vaccine in 2020, the vast majority do not complete the full vaccination series, leaving them without maximum protection.
(5)Condoms are an effective tool to reduce STI transmission, but condom use among sexually active teens has declined over the last decade. The CDCs Youth Risk Behavior Surveillance System (YRBSS) shows that in 2019, an average of 20 percent of California high school pupils were sexually active and 47 percent of those pupils did not use condoms during their last sexual intercourse.
(6)Teens face multiple barriers to accessing condoms that deter them from seeking and securing the resources they need to protect themselves against STIs and unintended pregnancy. Through Essential Access Healths TeenSource Condom Access Project, young people reported that cost is the biggest obstacle to obtaining condoms. When cost barriers remain, youth with low incomes are often left without the option to regularly use condoms to help protect their health and prevent an unintended pregnancy from occurring.
(7)Though most health plans, including Medi-Cal, will be required to cover condoms as a no-cost over-the-counter benefit beginning in 2024, this benefit will only be extended to women. Young males will not be able to access condoms over the counter for free using their health coverage, and uninsured individuals will have to continue to pay out of pocket.
(8)Teens have also long reported experiencing difficulties while attempting to purchase condoms at some pharmacies and retailers, including being judged, shamed, or harassed, or being asked to show an identification card despite the fact that there are no age requirements for condom purchases.
(9)Condom availability programs in schools began in the early 1990s, and are a key and cost-effective strategy for helping to prevent HIV, STIs, and pregnancy among teens. According to the CDC, only 7.2 percent of high schools and 2.3 percent of middle schools made condoms available to pupils in 2014. Studies conducted by the CDC also found that condom access programs in schools did not increase sexual activity among teens and can increase condom use among sexually active pupils and pupils at high risk.
(10)In 2020, Vermont became the first state in the country to require public secondary schools to make free condoms readily available to pupils. The Society for Adolescent Health and Medicine strongly supports access to free condoms in schools in easily accessible locations, such as school-based health centers and clinics, nurses offices, and bathrooms.
(11)California has an interest in promoting and expanding equitable access to tools and resources that empower youth to make healthier choices and reduce the spread of STIs.
(b)Therefore, it is the intent of the Legislature to improve public health outcomes and reduce STI rates among California youth by making condoms more accessible for young people and ensuring there is no wrong door for HPV vaccine access.
SEC. 2.Section 35292.7 is added to the Education Code, to read:35292.7.(a)In order to prevent and reduce unintended pregnancies and sexually transmitted infections, on or before the start of the 202425 school year, each public school shall make internal and external condoms available to all pupils in grades 9 to 12, inclusive, free of charge. Each public school shall distribute condoms in the following manner:
(1)Condoms shall be placed in a minimum of two locations on school grounds where the condoms are easily accessible to pupils during school hours without requiring assistance or permission from school staff.
(2)Condoms placed in unsupervised locations shall be stored in tamper-proof dispensers.
(b)A public school described in subdivision (a) shall, at the beginning of each school year, inform pupils through existing school communication channels that free condoms are available and where the condoms can be obtained on school grounds.
(c)Commencing with the 202425 school year, each public school A public school, as described in subdivision (a), shall post at least one notice regarding the requirements of this section in a prominent and conspicuous location on the school campus. and shall prominently and conspicuously display the notice on the school campus in appropriate areas that are accessible to, and commonly frequented by, pupils. This notice shall include all of the following:
(1)The text of this section.
(2)The contact information, including an email address and telephone number, for a designated individual responsible for maintaining the requisite supply of condoms.
(3)Information that abstinence from sexual activity and injection drug use is the only certain way to prevent HIV and other sexually transmitted infections and that abstinence from sexual intercourse is the only certain way to prevent unintended pregnancy.
(4)Information about how to use condoms properly.
(5)Information on how to access local resources and pupils legal rights to access local resources for sexual and reproductive health care such as testing and medical care for HIV and other sexually transmitted infections and pregnancy prevention and care, as well as local resources for assistance with sexual assault and intimate partner violence.
(d)Each public school serving any of grades 7 to 12, inclusive, shall allow the distribution of condoms during the course of, or in connection to, with, educational or public health programs and initiatives, including, but not limited to, from any of the following:
(1)Community organizations or other entities providing instruction for purposes of the California Healthy Youth Act (Chapter 5.6 (commencing with Section 51930) of Part 28 of Division 4).
(2)Pupil peer health programs, clubs, or groups.
(3)Pupil health fairs conducted on campus.
(4)School-based health center staff.
(e)A state agency, the department, or a public school may accept gifts, grants, and donations from any source for the support of a public school carrying out the provisions of this section, including, but not limited to, the acceptance of condoms from a manufacturer or wholesaler.
(e)(f)For purposes of this section, public school includes a school operated by a school district, a school operated by a county office of education, and a charter school.
SEC. 3.Article 15 (commencing with Section 49595) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, to read:15.Miscellaneous Provisions49595.School-based health center sites located on school campuses (a)A public school maintaining any combination of classrooms from grades 7 to 12, inclusive, may shall not be prohibited prohibit a school-based health center from making internal and external condoms available and easily accessible at the school-based health center site to all pupils free of charge. to pupils.
(b)For purposes of this section, the following definitions apply:
(1)Public school includes a school operated by a school district, a school operated by a county office of education, and a charter school.
(2)(A)School-based health center means a center or program, located at or near a public school, that provides age-appropriate health care services at the program site or through referrals.
(B)A school-based health center includes a center or program described in subparagraph (A) that may conduct routine physical, mental health, and oral health assessments, and provide referrals for any services not offered onsite.
(C)A school-based health center includes a center or program described in subparagraph (A) that may serve two or more nonadjacent schools or local educational agencies.
SEC. 4.Chapter 7.7 (commencing with Section 111823) is added to Part 5 of Division 104 of the Health and Safety Code, to read:7.7.Nonprescription Contraception111823.(a)A retail establishment shall not refuse to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age.
(b)Section 111825 does not apply to a violation of subdivision (a).
(c)Subdivision (a) does not apply to the refusal to furnish nonprescription contraception on the basis of age if, under other provisions of federal or state law, the contraception is subject to restrictions on the basis of age.
(d)For purposes of this section, retail establishment means any vendor that, in the regular course of business, furnishes nonprescription contraception at retail directly to the public, including, but not limited to, a pharmacy, grocery store, or other retail store.
SEC. 5.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 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.
(H)Coverage for immunization against human papillomavirus (HPV), as clinically indicated, to persons who are 18 years of age or younger. This subparagraph shall not be construed as prohibiting the department from providing that coverage to persons who are over 18 years of age through the Family PACT Program.
(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.
(ag)(1)Violence prevention services are covered, subject to medical necessity and utilization controls.
(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, may 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.
(4)The department shall post on its internet website the date upon which violence prevention services may be provided and billed pursuant to this subdivision.
(5)Violence prevention services means evidence-based, trauma-informed, and culturally responsive preventive services provided to reduce the incidence of violent injury or reinjury, trauma, and related harms and promote trauma recovery, stabilization, and improved health outcomes.
SEC. 6.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)The Legislature finds and declares all of the following:
(1)The federal Centers for Disease Control and Prevention (CDC) estimates that one in five people in the United States have a sexually transmitted infection (STI). More than 325,000 Californians were infected with syphilis, chlamydia, or gonorrhea in 2019.
(2)California youth, and in particular youth of color, are disproportionately impacted by the STI crisis. Statewide data indicate over half of all STIs in the state are experienced among California youth 15 to 24 years of age, inclusive. Young people in this age group make up more than 5 out of every 10 chlamydia cases in California, and more than 87 percent are youth of color.
(3)Untreated STIs can lead to serious long-term health consequences. The CDC estimates that untreated STIs cause at least 24,000 women in the United States each year to become infertile. The human papillomavirus (HPV) can lead to increased risk of developing cancer. The number of HPV-related cancers in men dramatically increased in 2016.
(4)Vaccination rates against HPV are down nationwide due to the COVID-19 pandemic, putting teens and young people at risk of developing HPV-related cancers later in life. While nearly 80 percent of California teens received the first of three doses of the HPV vaccine in 2020, the vast majority do not complete the full vaccination series, leaving them without maximum protection.
(5)Condoms are an effective tool to reduce STI transmission, but condom use among sexually active teens has declined over the last decade. The CDCs Youth Risk Behavior Surveillance System (YRBSS) shows that in 2019, an average of 20 percent of California high school pupils were sexually active and 47 percent of those pupils did not use condoms during their last sexual intercourse.
(6)Teens face multiple barriers to accessing condoms that deter them from seeking and securing the resources they need to protect themselves against STIs and unintended pregnancy. Through Essential Access Healths TeenSource Condom Access Project, young people reported that cost is the biggest obstacle to obtaining condoms. When cost barriers remain, youth with low incomes are often left without the option to regularly use condoms to help protect their health and prevent an unintended pregnancy from occurring.
(7)Though most health plans, including MediCal, Medi-Cal, will be required to cover condoms as a no-cost over-the-counter benefit beginning in 2024, this benefit will only be extended to women. Young males will not be able to access condoms over the counter for free using their health coverage, and uninsured individuals will have to continue to pay out of pocket.
(8)Teens have also long reported experiencing difficulties while attempting to purchase condoms at some pharmacies and retailers, including being judged, shamed, or harassed, or being asked to show an identification card despite the fact that there are no age requirements for condom purchases.
(9)Condom availability programs in schools began in the early 1990s, and are a key and cost-effective strategy for helping to prevent HIV, STIs, and pregnancy among teens. According to the CDC, only 7.2 percent of high schools and 2.3 percent of middle schools made condoms available to pupils in 2014. Studies conducted by the CDC also found that condom access programs in schools did not increase sexual activity among teens and can increase condom use among sexually active pupils and pupils at high risk.
(10)In 2020, Vermont became the first state in the country to require public secondary schools to make free condoms readily available to pupils. The Society for Adolescent Health and Medicine strongly supports access to free condoms in schools in easily accessible locations, such as school-based health centers and clinics, nurses offices, and bathrooms.
(11)California has an interest in promoting and expanding equitable access to tools and resources that empower youth to make healthier choices and reduce the spread of STIs.
(b)Therefore, it is the intent of the Legislature to improve public health outcomes and reduce STI rates among California youth by making condoms more accessible for young people and ensuring there is no wrong door for HPV vaccine access.
SEC. 2.Section 35292.7 is added to the Education Code, to read:35292.7.(a)In order to prevent and reduce unintended pregnancies and sexually transmitted infections, on or before the start of the 202425 school year, each public school shall make internal and external condoms available to all pupils free of charge. Public school administrative teams, in consultation with their nursing staff, shall determine the best manner in which to make condoms available to pupils. At a minimum, condoms shall be placed in locations that are safe and readily accessible to pupils. Each public school shall distribute condoms in the following manner:
(1)Condoms shall be placed in a minimum of two locations on school grounds where the condoms are easily accessible to pupils during school hours without requiring assistance or permission from school staff.
(2)Condoms placed in unsupervised locations shall be stored in tamper-proof dispensers.
(b)A public school described in subdivision (a) shall, at the beginning of each school year, inform pupils through existing school communication channels that free condoms are available and where the condoms can be obtained on school grounds.
(b)(c)Commencing with the 202324 202425 school year, each public school shall post at least one notice regarding the requirements of this section in a prominent and conspicuous location on the school campus. This notice shall include the text of this section and contact information, including an email address and telephone number, for a designated individual responsible for maintaining the requisite supply of condoms. all of the following:
(1)The text of this section.
(2)The contact information, including an email address and telephone number, for a designated individual responsible for maintaining the requisite supply of condoms.
(3)Information that abstinence from sexual activity and injection drug use is the only certain way to prevent HIV and other sexually transmitted infections and that abstinence from sexual intercourse is the only certain way to prevent unintended pregnancy.
(4)Information about how to use condoms properly.
(5)Information on how to access local resources and pupils legal rights to access local resources for sexual and reproductive health care such as testing and medical care for HIV and other sexually transmitted infections and pregnancy prevention and care, as well as local resources for assistance with sexual assault and intimate partner violence.
(c)(d)Each public school serving any of grades 7 to 12, inclusive, shall allow the distribution of condoms during the course of, or in connection to, educational or public health programs and initiatives, including, but not limited to, from any of the following:
(1)Community organizations or other entities contracted to provide providing instruction for purposes of the California Healthy Youth Act (Chapter 5.6 (commencing with Section 51930) of Part 28 of Division 4).
(2)School-sanctioned pupil Pupil peer health programs, clubs, or groups.
(3)School-sanctioned pupil Pupil health fairs conducted on campus.
(4)School-based health center staff.
(d)(e)For purposes of this section, public school includes a school operated by a school district, a school operated by a county office of education, and a charter school.
SEC. 3.Article 15 (commencing with Section 49595) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, to read:15.Miscellaneous Provisions49595.School-based health center sites located on school campuses maintaining any combination of classrooms from grades 7 to 12, inclusive, may not be prohibited from making internal and external condoms available and easily accessible at the school-based health center site to all pupils free of charge.
SEC. 3.SEC. 4.Chapter 7.7 (commencing with Section 111823) is added to Part 5 of Division 104 of the Health and Safety Code, to read:7.7.Nonprescription Contraception111823.(a)A retail establishment shall not refuse to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age.
(b)Section 111825 does not apply to a violation of subdivision (a).
(c)Subdivision (a) does not apply to the refusal to furnish nonprescription contraception on the basis of age if, under other provisions of federal or state law, the contraception is subject to restrictions on the basis of age.
(d)For purposes of this section, retail establishment means any vendor that, in the regular course of business, furnishes nonprescription contraception at retail directly to the public, including, but not limited to, a pharmacy, grocery store, or other retail store.
SEC. 4.SEC. 5.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 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.
(H)Coverage for immunization against human papillomavirus (HPV), as clinically indicated, to persons who are 18 years of age or younger. This subparagraph shall not be construed as prohibiting the department from providing that coverage to persons who are over 18 years of age through the Family PACT Program.
(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.
(ag)(1)Violence prevention services are covered, subject to medical necessity and utilization controls.
(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, may 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.
(4)The department shall post on its internet website the date upon which violence prevention services may be provided and billed pursuant to this subdivision.
(5)Violence prevention services means evidence-based, trauma-informed, and culturally responsive preventive services provided to reduce the incidence of violent injury or reinjury, trauma, and related harms and promote trauma recovery, stabilization, and improved health outcomes.
SEC. 5.SEC. 6.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)The Legislature finds and declares all of the following:
(1)The federal Centers for Disease Control and Prevention (CDC) estimates that one in five people in the United States have a sexually transmitted infection (STI). More than 325,000 Californians were infected with syphilis, chlamydia, or gonorrhea in 2019.
(2)California youth, and in particular youth of color, are disproportionately impacted by the STI crisis. Statewide data indicate over half of all STIs in the state are experienced among California youth 15 to 24 years of age, inclusive. Young people in this age group make up more than 5 out of every 10 chlamydia cases in California, and more than 87 percent are youth of color.
(3)Untreated STIs can lead to serious long-term health consequences. The CDC estimates that untreated STIs cause at least 24,000 women in the United States each year to become infertile. The human papillomavirus (HPV) can lead to increased risk of developing cancer. The number of HPV-related cancers in men dramatically increased in 2016.
(4)Vaccination rates against HPV are down nationwide due to the COVID-19 pandemic, putting teens and young people at risk of developing HPV-related cancers later in life. While nearly 80 percent of California teens received the first of three doses of the HPV vaccine in 2020, the vast majority do not complete the full vaccination series, leaving them without maximum protection.
(5)Condoms are an effective tool to reduce STI transmission, but condom use among sexually active teens has declined over the last decade. The CDCs Youth Risk Behavior Surveillance System (YRBSS) shows that in 2019, an average of 20 percent of California high school pupils were sexually active and 47 percent of those pupils did not use condoms during their last sexual intercourse.
(6)Teens face multiple barriers to accessing condoms that deter them from seeking and securing the resources they need to protect themselves against STIs and unintended pregnancy. Through Essential Access Healths TeenSource Condom Access Project, young people reported that cost is the biggest obstacle to obtaining condoms. When cost barriers remain, youth with low incomes are often left without the option to regularly use condoms to help protect their health and prevent an unintended pregnancy from occurring.
(7)Though most health plans, including MediCal, will be required to cover condoms as a no-cost over-the-counter benefit beginning in 2024, this benefit will only be extended to women. Young males will not be able to access condoms over the counter for free using their health coverage, and uninsured individuals will have to continue to pay out of pocket.
(8)Teens have also long reported experiencing difficulties while attempting to purchase condoms at some pharmacies and retailers, including being judged, shamed, or harassed, or being asked to show an identification card despite the fact that there are no age requirements for condom purchases.
(9)Condom availability programs in schools began in the early 1990s, and are a key and cost-effective strategy for helping to prevent HIV, STIs, and pregnancy among teens. According to the CDC, only 7.2 percent of high schools and 2.3 percent of middle schools made condoms available to pupils in 2014. Studies conducted by the CDC also found that condom access programs in schools did not increase sexual activity among teens and can increase condom use among sexually active pupils and pupils at high risk.
(10)In 2020, Vermont became the first state in the country to require public secondary schools to make free condoms readily available to pupils. The Society for Adolescent Health and Medicine strongly supports access to free condoms in schools in easily accessible locations, such as school-based health centers and clinics, nurses offices, and bathrooms.
(11)California has an interest in promoting and expanding equitable access to tools and resources that empower youth to make healthier choices and reduce the spread of STIs.
(b)Therefore, it is the intent of the Legislature to improve public health outcomes and reduce STI rates among California youth by making condoms more accessible for young people and ensuring there is no wrong door for HPV vaccine access.
SEC. 2.Section 35292.7 is added to the Education Code, to read:35292.7.(a)In order to prevent and reduce unintended pregnancies and sexually transmitted infections, each public school shall make condoms available to all pupils free of charge. Public school administrative teams, in consultation with their nursing staff, shall determine the best manner in which to make condoms available to pupils. At a minimum, condoms shall be placed in locations that are safe and readily accessible to pupils.
(b)Commencing with the 202324 school year, each public school shall post at least one notice regarding the requirements of this section in a prominent and conspicuous location on the school campus. This notice shall include the text of this section and contact information, including an email address and telephone number, for a designated individual responsible for maintaining the requisite supply of condoms.
(c)Each public school serving any of grades 7 to 12, inclusive, shall allow the distribution of condoms during the course of, or in connection to, educational or public health programs and initiatives, including, but not limited to, from any of the following:
(1)Community organizations or other entities contracted to provide instruction for purposes of the California Healthy Youth Act (Chapter 5.6 (commencing with Section 51930) of Part 28 of Division 4).
(2)School-sanctioned pupil peer health programs, clubs, or groups.
(3)School-sanctioned pupil health fairs conducted on campus.
(4)School-based health center staff.
(d)For purposes of this section, public school includes a school operated by a school district, a school operated by a county office of education, and a charter school.
SEC. 3.Chapter 7.7 (commencing with Section 111823) is added to Part 5 of Division 104 of the Health and Safety Code, to read:7.7.Nonprescription Contraception111823.(a)A retail establishment shall not refuse to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age.
(b)Section 111825 does not apply to a violation of subdivision (a).
(c)Subdivision (a) does not apply to the refusal to furnish nonprescription contraception on the basis of age if, under other provisions of federal or state law, the contraception is subject to restrictions on the basis of age.
(d)For purposes of this section, retail establishment means any vendor that, in the regular course of business, furnishes nonprescription contraception at retail directly to the public, including, but not limited to, a pharmacy, grocery store, or other retail store.
SEC. 4.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 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.
(H)Coverage for immunization against human papillomavirus (HPV), as clinically indicated, to persons who are 18 years of age or younger. This subparagraph shall not be construed as prohibiting the department from providing that coverage to persons who are over 18 years of age through the Family PACT Program.
(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.
(ag)(1)Violence prevention services are covered, subject to medical necessity and utilization controls.
(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, may 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.
(4)The department shall post on its internet website the date upon which violence prevention services may be provided and billed pursuant to this subdivision.
(5)Violence prevention services means evidence-based, trauma-informed, and culturally responsive preventive services provided to reduce the incidence of violent injury or reinjury, trauma, and related harms and promote trauma recovery, stabilization, and improved health outcomes.
SEC. 5.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
|
Date
|
Status
|
|---|---|
| Jan 25, 2024 | Veto sustained. |
| Jan 25, 2024 | Stricken from file. |
| Oct 8, 2023 | In Senate. Consideration of Governor's veto pending. |
| Oct 8, 2023 | Vetoed by the Governor. |
| Sep 15, 2023 | Enrolled and presented to the Governor at 3 p.m. |
| Sep 11, 2023 | Assembly amendments concurred in. (Ayes 30. Noes 9. Page 2601.) Ordered to engrossing and enrolling. |
| Sep 7, 2023 | In Senate. Concurrence in Assembly amendments pending. |
| Sep 7, 2023 | Read third time. Passed. (Ayes 65. Noes 11. Page 3004.) Ordered to the Senate. |
| Sep 5, 2023 | Read second time. Ordered to third reading. |
| Sep 1, 2023 | Read second time and amended. Ordered to second reading. |
| Sep 1, 2023 | From committee: Do pass as amended. (Ayes 11. Noes 4.) (September 1). |
| Aug 23, 2023 | August 23 set for first hearing. Placed on suspense file. |
| Jul 12, 2023 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 12. Noes 3.) (July 11). Re-referred to Com. on APPR. |
| Jun 30, 2023 | Read second time and amended. Re-referred to Com. on HEALTH. |
| Jun 29, 2023 | From committee: Do pass as amended and re-refer to Com. on HEALTH. (Ayes 5. Noes 1.) (June 28). |
| Jun 15, 2023 | Referred to Coms. on ED. and HEALTH. |
| Jun 1, 2023 | In Assembly. Read first time. Held at Desk. |
| May 31, 2023 | Reconsideration granted. (Ayes 40. Noes 0. Page 1398.) |
| May 31, 2023 | Read third time. Passed. (Ayes 31. Noes 9. Page 1398.) Ordered to the Assembly. |
| May 31, 2023 | Read third time. Passed. (Ayes 31. Noes 8. Page 1393.) Ordered to the Assembly. |
| May 31, 2023 | Motion to reconsider made by Senator Menjivar. |
| May 22, 2023 | Read second time. Ordered to third reading. |
| May 18, 2023 | Read second time and amended. Ordered to second reading. |
| May 18, 2023 | From committee: Do pass as amended. (Ayes 5. Noes 2. Page 1174.) (May 18). |
| May 12, 2023 | Set for hearing May 18. |
| Apr 24, 2023 | April 24 hearing: Placed on APPR suspense file. |
| Apr 18, 2023 | Set for hearing April 24. |
| Apr 13, 2023 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 10. Noes 1. Page 710.) (April 12). Re-referred to Com. on APPR. |
| Apr 3, 2023 | Set for hearing April 12. |
| Mar 30, 2023 | Read second time and amended. Re-referred to Com. on HEALTH. |
| Mar 29, 2023 | From committee: Do pass as amended and re-refer to Com. on HEALTH. (Ayes 5. Noes 2. Page 570.) (March 29). |
| Mar 20, 2023 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on ED. |
| Mar 8, 2023 | Set for hearing March 29. |
| Feb 22, 2023 | Referred to Coms. on ED. and HEALTH. |
| Feb 15, 2023 | From printer. May be acted upon on or after March 17. |
| Feb 14, 2023 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Sep 11, 2023 | Unfinished Business SB541 Menjivar et al. Concurrence | Senate Floor |
Passed |
|
| Sep 7, 2023 | SB 541 Menjivar Senate Third Reading By Wilson | Assembly Floor |
Passed |
|
| Sep 1, 2023 | Do pass as amended. | Assembly Standing Committee on Appropriations |
Passed |
|
| Jul 11, 2023 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Health |
Passed |
|
| Jun 28, 2023 | Do pass as amended and be re-referred to the Committee on [Health] | Assembly Standing Committee on Education |
Passed |
|
| May 31, 2023 | Senate 3rd Reading SB541 Menjivar et al. | Senate Floor |
Passed |
|
| May 31, 2023 | Senate 3rd Reading SB541 Menjivar et al. Reconsider | Senate Floor |
Passed |
|
| May 31, 2023 | Senate 3rd Reading SB541 Menjivar et al. | Senate Floor |
Passed |
|
| May 18, 2023 | Do pass as amended | Senate Standing Committee on Appropriations |
Passed |
|
| Apr 24, 2023 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Apr 12, 2023 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
|
| Mar 29, 2023 | Do pass as amended, but first amend, and re-refer to the Committee on [Health] | Senate Standing Committee on Education |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| Access Reproductive Justice | ** Support | |
| Aclu California Action | ** Support | |
| Act for Women and Girls | ** Support | |
| Adolescent Health Working Group | ** Support | |
| Aids Healthcare Foundation | ** Support | |
| Alameda County Board of Supervisors | ** Support | |
| American College Of Obstetricians And Gynecologists District Ix | ** Support | |
| American Nurses Association | * Support | Mar 29, 2023 |
| APLA Health | * Support | Jul 11, 2023 |
| Black Women For Wellness Action Project | ** Support | |
| California Academy Of Family Physicians | ** Support | |
| California Coalition For Youth | ** Support | |
| California Faculty Association | ** Support | |
| California Family Council | ** Against | |
| California Federation Of Teachers | ** Support | |
| California Health Plus Advocates | * Support | Jul 11, 2023 |
| California Health+AdvocatesCalifornia Nurse Midwives Association | ** Support | |
| California Medical Association | * Support | Apr 12, 2023 |
| California Nurse Members Association | * Support | Jul 11, 2023 |
| California Nurse Midwives Association | ** Support | |
| California Parents Union | * Against Unless Amend | Jun 28, 2023 |
| California Policy Center | ** Against | |
| California School-Based Health Alliance | ** Support | |
| California Teachers Association | ** Support | |
| California Women's Law Center | ** Support | |
| CAPSLO the Center for Health & Prevention | ** Support | |
| Citizens for Choice | ** Support | |
| Coachman Moore & Associates | ** Support | |
| Coachman Moore and Associates | ** Support | |
| Community Clinic Association of Los Angeles County | ** Support | |
| Desert Aids Project D/b/a Dap Health | ** Support | |
| DPA | ** Support | |
| DPA Health | ** Support | |
| End Epidemics Coalition In California | ** Support | Apr 12, 2023 |
| Equality California | * Support | Jul 11, 2023 |
| Essential Access Health | ** Support | |
| Essential Health Access | * Support | Mar 29, 2023 |
| Feminist Majority Foundation | ** Support | |
| Genders & Sexualities Alliance Network | ** Support | |
| Generation Up | ** Support | |
| Glide | ** Support | |
| Los Angeles LGBT Center | ** Support | |
| Medicare for Everyone Everywhere | * Support | Mar 29, 2023 |
| NARAL Pro-Choice California | ** Support | |
| National Center for Youth Law | ** Support | |
| National Harm Reduction Coalition | ** Support | |
| National Health Law Program | ** Support | |
| Planned Parenthood Affiliates Of California | ** Support | |
| Radiant Health Centers | ** Support | |
| Rainbow Pride Youth Alliance | ** Support | |
| REACH LA | ** Support | |
| Realistic Education in Action Coalition to Foster Health | ** Support | |
| Rosemont High School | * Support | Jun 28, 2023 |
| San Francisco Aids Foundation | ** Support | |
| TEACH | ** Support | |
| the la trust for children's health | ** Support | |
| the los angeles trust for children's health | ** Support | |
| Traditional Biblical Values | * Against | Mar 29, 2023 |
| Training In Early Abortion For Comprehensive Healthcare | ** Support | |
| Two individuals | ** Against | |
| UC Berkeley | * Support | Apr 12, 2023 |
| UCLA Bixby Center on Population and Reproductive Health | ** Support | |
| Unite for Reproductive & Gender Equity | ** Support | |
| University of California San Francisco | * Support | Mar 29, 2023 |
| URGE CA | ** Support | |
| URGE Califoria | ** Support | |
| URGE: Unite for Reproductive & Gender Equity | ** Support | |
| Women's Foundation of California, Dr. Beatriz Maria Solis Policy Institute | ** Support | |
| Women's Health Specialists | ** Support |
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 541 |
VETO
Bill No: SB 541
Author: Menjivar (D), et al.
Amended: 9/1/23
Vote: 27
SENATE EDUCATION COMMITTEE: 5-2, 3/29/23
AYES: Newman, Cortese, Glazer, McGuire, Smallwood-Cuevas
NOES: Ochoa Bogh, Wilk
SENATE HEALTH COMMITTEE: 10-1, 4/12/23
AYES: Eggman, Glazer, Gonzalez, Hurtado, Limón, Menjivar, Roth, Rubio, Wahab, Wiener
NOES: Nguyen
NO VOTE RECORDED: Grove
SENATE APPROPRIATIONS COMMITTEE: 5-2, 5/18/23
AYES: Portantino, Ashby, Bradford, Wahab, Wiener
NOES: Jones, Seyarto
SENATE FLOOR: 31-8, 5/31/23
AYES: Allen, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dodd, Durazo, Eggman, Glazer, Gonzalez, Hurtado, Laird, Limón, McGuire, Menjivar, Min, Newman, Padilla, Portantino, Roth, Rubio, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener
NOES: Alvarado-Gil, Dahle, Jones, Nguyen, Niello, Ochoa Bogh, Seyarto, Wilk
NO VOTE RECORDED: Grove
SENATE FLOOR: 30-9, 9/11/23
AYES: Allen, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Cortese, Dodd, Durazo, Eggman, Glazer, Gonzalez, Hurtado, Laird, Limón, McGuire, Menjivar, Min, Newman, Padilla, Portantino, Roth, Rubio, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener
NOES: Alvarado-Gil, Dahle, Grove, Jones, Nguyen, Niello, Ochoa Bogh, Seyarto, Wilk
NO VOTE RECORDED: Caballero
ASSEMBLY FLOOR: 65-11, 9/7/23 - See last page for vote
SUBJECT: Sexual health: contraceptives
SOURCE: Adolescent Health Working Group
Black Women for Wellness Action Project
Citizens for Choice
Essential Access Health
Generation Up
Unite for Reproductive & Gender Equity
DIGEST:
This bill requires all public high schools to make condoms available to students by the start of the 2024-25 school year, and requires schools to provide information to students on the availability of condoms, as well as other sexual health information. This bill prohibits public schools from preventing distribution of condoms or preventing a school-based health center from making condoms available and easily accessible to students at the school-based health center site. This bill also prohibits retailers from restricting sales of nonprescription contraception on the basis of age.
ANALYSIS:
Existing law:
- Establishes the California Healthy Youth Act (CHYA), which requires local educational agencies (LEAs) to provide comprehensive sexual health and HIV prevention instruction to all students in grades 7 to 12, at least once in middle school and once in high school. (Education Code (EC) § 51933)
- Authorizes an LEA to contract with outside consultants or guest speakers, including those who have developed multilingual curricula or curricula accessible to persons with disabilities, to deliver comprehensive sexual health education and HIV prevention education or to provide training for school district personnel. All outside consultants and guest speakers shall have expertise in comprehensive sexual health education and HIV prevention education and have knowledge of the most recent medically accurate research on the relevant topic or topics covered in their instruction. (EC § 51936)
- Requires that pupils in grades 7 to 12, inclusive, receive comprehensive sexual health education at least once in junior high or middle school and at least once in high school. (EC § 51934)
4) Requires that the instruction and related instructional materials be, among other things:
a) Age appropriate.
b) Medically accurate and objective.
c) Appropriate for use with pupils of all races, genders, sexual orientations, and ethnic and cultural backgrounds, pupils with disabilities, and English learners.
d) Made available on an equal basis to a pupil who is an English learner, consistent with the existing curriculum and alternative options for an English learner pupil.
e) Accessible to pupils with disabilities. (EC § 51934)
- Authorizes an LEA to provide comprehensive sexual health education and HIV prevention education earlier than grade seven using instructors trained in the appropriate courses and age-appropriate and medically-accurate information. (EC § 51933)
- Requires LEAs to provide parents and guardians with a notice at the beginning of each school year, or, for a pupil who enrolls in a school after the beginning of the school year, at the time of that pupil’s enrollment the following:
a) About instruction in comprehensive sexual health education and HIV prevention education and research on pupil health behaviors and risks planned for the coming year.
b) Advise the parent or guardian that the educational materials used in sexual health education are available for inspection.
c) Advise the parent or guardian whether the comprehensive sexual health education or HIV prevention education will be taught by school district personnel or by outside consultant, as provided.
d) Advise the parent or guardian that the parent or guardian has the right to excuse their child from comprehensive sexual health education and HIV prevention education and that in order to excuse their child they must state their request in writing to the LEA. (EC § 51938)
- Provides that the parent or guardian of a pupil has the right to excuse their child from all or part of that education, including related assessments, through a passive consent (“opt-out”) process. (EC § 51938)
This bill:
- Requires, on or before the start of the 2024–25 school year, each public school to make condoms available to all pupils in grades 9 to 12, inclusive, free of charge, and requires related information to be made available to students.
- Requires each public school serving any of grades 7 to 12, inclusive, to allow condoms to be made available during the course of, or in connection with, educational or public health programs and initiatives, as specified.
- Requires public schools, serving any of grades 7 to 12, to allow a school-based health center to make internal and external condoms available and easily accessible to pupils at the school-based health center site.
- Prohibits a retail establishment from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age, unless the contraception is otherwise subject to restriction on the basis of age. Specifies that penalties do not apply for non-compliance.
Comments
- Need for this bill. According to the author “ By requiring free condoms in all California high schools, we are empowering the youth who decide to become sexually active to protect themselves and their partners from STIs, while also removing barriers that potentially shame them and lead to unsafe sex. Further, requiring the Family PACT program to cover HPV vaccinations for ages 12-18 will decrease instances of patients delaying vaccination or becoming discouraged after being turned away. These programs can instill safe sexual habits among youth, protecting themselves now and into adulthood.”
- California Healthy Youth Act. The CHYA took effect in 2003 and was initially known as the Comprehensive Sexual Health and HIV/AIDS Prevention Education Act. Originally, the act LEAs to provide comprehensive sexual health education in any grade, including kindergarten, so long as it consisted of age-appropriate instruction and used instructors trained in the appropriate courses. Beginning in 2016 with AB 329 (Weber, 2015), the act was renamed the CHYA and, for the first time, required LEAs, excluding charter schools, to provide comprehensive sexual health education and HIV prevention education to all students at least once in middle school and at least once in high school. Charter schools must also provide that same instruction. From its inception in 2003 through today, the CHYA has always afforded parents the right to opt their child out of a portion, or all, of the instruction and required LEAs to notify parents and guardians of this right. Parents and guardians can exercise this right by informing the LEA in writing of their decision.
- Comprehensive sexual health education in lower grades. Comprehensive sexual health education in lower grades has always been, and remains, optional. Under existing law, for grades 6 and below, an LEA must “opt-in” to offer that instruction to students. The LEA is then required by law to notify parents and guardians of their right to “opt-out” their child, whether in part or completely. All instruction and materials in grades K–6 must meet the instructional criteria or baseline requirements of the CHYA and the content that is required in grades 7–12 may be also be included in an age-appropriate way in earlier grades.
- 2019 Revision of the Health Education Framework. On May 8, 2019, the State Board of Education (SBE) officially adopted the 2019 Health Education Curriculum Framework for California Public Schools (the Health Education Framework) after over two years of development. The Health Education Framework is aligned to the 2008 California Health Education Content Standards, which support the development of knowledge, skills, and attitudes in eight overarching standards: (1) essential health concepts; (2) analyzing health influences; (3) accessing valid health information; (4) interpersonal communication; (5) decision making; (6) goal setting; (7) practicing health-enhancing behaviors; and (8) health promotion in six content areas of health education, including sexual health.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes
According to Assembly Appropriations Committee, “Ongoing Proposition 98 General Fund costs, of an unknown amount but potentially in the low millions of dollar annually, to schools to purchase condoms and inform students of the condoms’ availability annually. One-time costs, of an unknown amount, to buy and install tamper-proof dispensers in certain situations and to post a notice with certain information. Costs ultimately would depend on how many condoms schools make available and the number of schools installing tamper-proof dispensers. According to the California Department of Education, 1.9 million students enrolled in grades nine through 12 in over 4,000 schools in the 2022-23 school year. According to Planned Parenthood, external condoms usually cost less than $1 each if bought in packs of 12 or more on the private market. Internal condoms cost significantly more. The California Department of Public Health (CDPH) provides discounted rates to certain entities of external condoms, which are $100 per 1,000, and internal condoms, which are $730 per 500. Tamper-proof condom dispensers tend to cost in the low hundreds of dollars each. If each school serving students in grades nine through 12 provided 1,000 external condoms and 500 internal condoms at the CDPH rates, and one tamper-proof dispenser, costs would total $4 million statewide. Costs could be less or more depending on the number of condoms provided, the cost of those condoms, and the locations of those condoms. If the Commission on State Mandates (CSM) determines the bill’s requirements to be a reimbursable state mandate, the state would need to reimburse these costs to local educational agencies or provide funding through the K-12 Mandate Block Grant. State law requiring schools to provide free menstrual products recently was determined by the CSM to be a state mandated cost and the cost of the mandate was added to the K-12 Mandate Block Grant. Ongoing General Fund costs of an unknown amount, potentially in the low tens of millions of dollars, for FPACT programs to provide coverage for immunization against HPV to certain individuals. Costs would ultimately depend on the number of individuals accessing the benefit. If FPACT programs applied to the federal Vaccines for Children program, these costs would be largely offset by a 90% federal match.”
SUPPORT: (Verified 10/20/23)
Adolescent Health Working Group (co-source)
Black Women for Wellness Action Project (co-source)
Citizens for Choice (co-source)
Essential Access Health (co-source)
Generation Up (co-source)
Unite for Reproductive & Gender Equity (co-source)
Access Reproductive Justice
ACLU California Action
ACT for Women and Girls
Aids Healthcare Foundation
Alameda County Board of Supervisors
American College of Obstetricians and Gynecologists District IX
California Academy of Family Physicians
California Coalition for Youth
California Faculty Association
California Federation of Teachers
California Health+AdvocatesCalifornia Nurse Midwives Association
California School-Based Health Alliance
California Teachers Association
California Transgender Advisory Council - Office of Lieutenant Governor
California Women's Law Center
Capslo the Center for Health & Prevention
Coachman Moore and Associates
Community Clinic Association of Los Angeles County
DPA Health
Feminist Majority Foundation
Genders & Sexualities Alliance Network
GLIDE
Los Angeles LGBT Center
NARAL Pro-choice California
National Center for Youth Law
National Harm Reduction Coalition
National Health Law Program
Planned Parenthood Affiliates of California
Radiant Health Centers
Rainbow Pride Youth Alliance
Realistic Education in Action Coalition to Foster Health
San Francisco Aids Foundation
The Los Angeles Trust for Children's Health
Training in Early Abortion for Comprehensive Health Care
UCLA Bixby Center on Population and Reproductive Health
Women's Foundation of California, Dr. Beatriz Maria Solis Policy Institute
Women's Health Specialists
OPPOSITION: (Verified 10/20/23)
California Family Council
California Policy Center
ARGUMENTS IN SUPPORT: According to the California School-Based Health Alliance writes:
More than 325,000 Californians were infected with syphilis, chlamydia, or gonorrhea in 2019. Young people, and in particular youth of color, are disproportionately impacted. Statewide data indicate over half of all STIs in the state are experienced among California youth ages 15 – 24 years old. Young people in this age group make up more than five out of every 10 chlamydia cases in California, and more than 87% are youth of color. Condoms are an effective tool to reduce STI transmission, but condom use among sexually active teens has declined over the last decade. The CDC's Youth Risk Behavior Surveillance System shows that in 2019, an average of 20% of California high school students were sexually active and 47% of those students did not use condoms during their last sexual intercourse. Teens have long reported facing multiple barriers to accessing condoms that deter them from seeking and securing the resources they need to protect themselves against STIs and unintended pregnancy. When barriers remain, youth with low-incomes are often left without the option to regularly utilize condoms to help protect their health and prevent an unintended pregnancy from occurring.
ARGUMENTS IN OPPOSITION: According to the California Family Council writes:
For the last decade or more this legislative body has been pushing condoms as the solution to sexually transmitted infections spreading among our youth. As the STI infection rate continued to rise, so did the insistence on easier access to condoms and information about safe sex at younger and younger ages. This was the whole argument surrounding the CA Healthy Youth Act passed in 2015, which mandates comprehensive sex education in every school district. Now in 2023, we have an STI epidemic on our hands. According to the California Department of Public Health, STIs are at epidemic levels. A 2020 report showed a 320% increase in syphilis over the past 10 years. Gonorrhea is up 190 percent. Despite these numbers, you still insist telling kids condoms will protect them. Why? Did you know condoms don't protect people from STIs such as herpes, genital warts, syphilis, and monkeypox, which can spread by skin-to-skin contact? Don't you think it is time to tell young people the truth, that those with the most fulfilling and healthy sex lives are those who treat sex as a special and intimate act to be shared in an opposite-sex, monogamous marriage? STIs can only thrive in a hook-up culture where sex is meaningless and done for fun with multiple partners. Handing out free condoms perpetuates such a culture. Please consider different options.
GOVERNOR'S VETO MESSAGE:
This bill requires all public high schools to make free condoms available to
students and would prohibit retailers from refusing to sell condoms to youth.
While evidence-based strategies, like increasing access to condoms, are important to supporting improved adolescent sexual health, this bill would create an unfunded mandate to public schools that should be considered in the annual budget process.
In partnership with the Legislature, we enacted a budget that closed a shortfall of more than $30 billion through balanced solutions that avoided deep program cuts and protected education, health care, climate, public safety, and social service programs that are relied on by millions of Californians. This year, however, the Legislature sent me bills outside of this budget process that, if all enacted, would add nearly $19 billion of unaccounted costs in the budget, of which $11 billion would be ongoing.
With our state facing continuing economic risk and revenue uncertainty, it is important to remain disciplined when considering bills with significant fiscal implications, such as this measure.
ASSEMBLY FLOOR: 65-11, 9/7/23
AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Connolly, Davies, Mike Fong, Friedman, Gabriel, Garcia, Gipson, Grayson, Haney, Hart, Holden, Irwin, Jackson, Jones-Sawyer, Kalra, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Luz Rivas, Rodriguez, Blanca Rubio, Santiago, Schiavo, Soria, Ting, Valencia, Villapudua, Waldron, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas
NOES: Megan Dahle, Dixon, Flora, Vince Fong, Gallagher, Lackey, Mathis, Jim Patterson, Joe Patterson, Sanchez, Ta
NO VOTE RECORDED: Chen, Essayli, Hoover, Wallis
Prepared by: Kordell Hampton / ED. / (916) 651-4105
10/25/23 10:52:43
**** END ****
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 541 |
UNFINISHED BUSINESS
Bill No: SB 541
Author: Menjivar (D), et al.
Amended: 9/1/23
Vote: 21
SENATE EDUCATION COMMITTEE: 5-2, 3/29/23
AYES: Newman, Cortese, Glazer, McGuire, Smallwood-Cuevas
NOES: Ochoa Bogh, Wilk
SENATE HEALTH COMMITTEE: 10-1, 4/12/23
AYES: Eggman, Glazer, Gonzalez, Hurtado, Limón, Menjivar, Roth, Rubio, Wahab, Wiener
NOES: Nguyen
NO VOTE RECORDED: Grove
SENATE APPROPRIATIONS COMMITTEE: 5-2, 5/18/23
AYES: Portantino, Ashby, Bradford, Wahab, Wiener
NOES: Jones, Seyarto
SENATE FLOOR: 31-9, 5/31/23
AYES: Allen, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dodd, Durazo, Eggman, Glazer, Gonzalez, Hurtado, Laird, Limón, McGuire, Menjivar, Min, Newman, Padilla, Portantino, Roth, Rubio, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener
NOES: Alvarado-Gil, Dahle, Grove, Jones, Nguyen, Niello, Ochoa Bogh, Seyarto, Wilk
ASSEMBLY FLOOR: 65-11, 9/7/23 - See last page for vote
SUBJECT: Sexual health: contraceptives: immunization
SOURCE: Adolescent Health Working Group
Black Women for Wellness Action Project
Citizens for Choice
Essential Access Health
Generation Up
Unite for Reproductive & Gender Equity
DIGEST:
This bill requires all public high schools to make condoms available to students by the start of the 2024-25 school year, and requires schools to provide information to students on the availability of condoms, as well as other sexual health information. Prohibits public schools from preventing distribution of condoms or preventing a school-based health center from making condoms available and easily accessible to students at the school-based health center site. Prohibits retailers from restricting sales of nonprescription contraception on the basis of age.
Assembly Amendments
- Add state special schools to the definition of public schools.
- Removes the requirement for the Family PACT to provide medical coverage for immunization against HPV to persons who are 18 years of age or younger, and clarifies that this does not prohibit the Department of Health Care Services (DHCS) from providing that coverage to persons who are over 18 years of age through the Family PACT Program.
- Remove tamper proof boxes and instead make condoms available to students via distribution, as specified.
ANALYSIS:
Existing law:
- Establishes the California Healthy Youth Act (CHYA), which requires local educational agencies (LEAs) to provide comprehensive sexual health and HIV prevention instruction to all students in grades 7 to 12, at least once in middle school and once in high school. (Education Code (EC) § 51933)
- Authorizes an LEA to contract with outside consultants or guest speakers, including those who have developed multilingual curricula or curricula accessible to persons with disabilities, to deliver comprehensive sexual health education and HIV prevention education or to provide training for school district personnel. All outside consultants and guest speakers shall have expertise in comprehensive sexual health education and HIV prevention education and have knowledge of the most recent medically accurate research on the relevant topic or topics covered in their instruction. (EC § 51936)
- Requires that pupils in grades 7 to 12, inclusive, receive comprehensive sexual health education at least once in junior high or middle school and at least once in high school. (EC § 51934)
4) Requires that the instruction and related instructional materials be, among other things:
a) Age appropriate.
b) Medically accurate and objective.
c) Appropriate for use with pupils of all races, genders, sexual orientations, and ethnic and cultural backgrounds, pupils with disabilities, and English learners.
d) Made available on an equal basis to a pupil who is an English learner, consistent with the existing curriculum and alternative options for an English learner pupil.
e) Accessible to pupils with disabilities. (EC § 51934)
- Authorizes an LEA to provide comprehensive sexual health education and HIV prevention education earlier than grade 7 using instructors trained in the appropriate courses and age-appropriate and medically-accurate information. (EC § 51933)
- Requires LEAs to provide parents and guardians with a notice at the beginning of each school year, or, for a pupil who enrolls in a school after the beginning of the school year, at the time of that pupil’s enrollment the following:
a) About instruction in comprehensive sexual health education and HIV prevention education and research on pupil health behaviors and risks planned for the coming year.
b) Advise the parent or guardian that the educational materials used in sexual health education are available for inspection.
c) Advise the parent or guardian whether the comprehensive sexual health education or HIV prevention education will be taught by school district personnel or by outside consultant, as provided.
d) Advise the parent or guardian that the parent or guardian has the right to excuse their child from comprehensive sexual health education and HIV prevention education and that in order to excuse their child they must state their request in writing to the LEA. (EC § 51938)
- Provides that the parent or guardian of a pupil has the right to excuse their child from all or part of that education, including related assessments, through a passive consent (“opt-out”) process. (EC § 51938)
This bill:
- Requires, on or before the start of the 2024–25 school year, each public school to make condoms available to all pupils in grades nine to 12, inclusive, free of charge, and requires related information to be made available to students.
- Requires each public school serving any of grades seven to 12, inclusive, to allow condoms to be made available during the course of, or in connection with, educational or public health programs and initiatives, as specified.
- Requires public schools, serving any of grades seven to 12, to allow a school-based health center to make internal and external condoms available and easily accessible to pupils at the school-based health center site.
- Prohibits a retail establishment from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age, unless the contraception is otherwise subject to restriction on the basis of age. Specifies that penalties do not apply for non-compliance.
Comments
- Need for the bill. According to the author “ By requiring free condoms in all California high schools, we are empowering the youth who decide to become sexually active to protect themselves and their partners from STIs, while also removing barriers that potentially shame them and lead to unsafe sex. Further, requiring the Family PACT program to cover HPV vaccinations for ages 12-18 will decrease instances of patients delaying vaccination or becoming discouraged after being turned away. These programs can instill safe sexual habits among youth, protecting themselves now and into adulthood.”
- California Healthy Youth Act. The CHYA took effect in 2003 and was initially known as the Comprehensive Sexual Health and HIV/AIDS Prevention Education Act. Originally, the act LEAs to provide comprehensive sexual health education in any grade, including kindergarten, so long as it consisted of age-appropriate instruction and used instructors trained in the appropriate courses. Beginning in 2016 with AB 329 (Weber, 2015), the act was renamed the CHYA and, for the first time, required LEAs, excluding charter schools, to provide comprehensive sexual health education and HIV prevention education to all students at least once in middle school and at least once in high school. Charter schools must also provide that same instruction. From its inception in 2003 through today, the CHYA has always afforded parents the right to opt their child out of a portion, or all, of the instruction and required LEAs to notify parents and guardians of this right. Parents and guardians can exercise this right by informing the LEA in writing of their decision.
- Comprehensive sexual health education in lower grades. Comprehensive sexual health education in lower grades has always been, and remains, optional. Under existing law, for grades 6 and below, an LEA must “opt-in” to offer that instruction to students. The LEA is then required by law to notify parents and guardians of their right to “opt-out” their child, whether in part or completely. All instruction and materials in grades K–6 must meet the instructional criteria or baseline requirements of the CHYA and the content that is required in grades 7–12 may be also be included in an age-appropriate way in earlier grades.
- 2019 Revision of the Health Education Framework. On May 8, 2019, the State Board of Education (SBE) officially adopted the 2019 Health Education Curriculum Framework for California Public Schools (the Health Education Framework) after over two years of development. The Health Education Framework is aligned to the 2008 California Health Education Content Standards, which support the development of knowledge, skills, and attitudes in eight overarching standards: (1) essential health concepts; (2) analyzing health influences; (3) accessing valid health information; (4) interpersonal communication; (5) decision making; (6) goal setting; (7) practicing health-enhancing behaviors; and (8) health promotion in six content areas of health education, including sexual health.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes
According to Assembly Appropriations Committee, “Ongoing Proposition 98 General Fund costs, of an unknown amount but potentially in the low millions of dollar annually, to schools to purchase condoms and inform students of the condoms’ availability annually. One-time costs, of an unknown amount, to buy and install tamper-proof dispensers in certain situations and to post a notice with certain information. Costs ultimately would depend on how many condoms schools make available and the number of schools installing tamper-proof dispensers. According to the California Department of Education, 1.9 million students enrolled in grades nine through 12 in over 4,000 schools in the 2022-23 school year. According to Planned Parenthood, external condoms usually cost less than $1 each if bought in packs of 12 or more on the private market. Internal condoms cost significantly more. The California Department of Public Health (CDPH) provides discounted rates to certain entities of external condoms, which are $100 per 1,000, and internal condoms, which are $730 per 500. Tamper-proof condom dispensers tend to cost in the low hundreds of dollars each. If each school serving students in grades nine through 12 provided 1,000 external condoms and 500 internal condoms at the CDPH rates, and one tamper-proof dispenser, costs would total $4 million statewide. Costs could be less or more depending on the number of condoms provided, the cost of those condoms, and the locations of those condoms. If the Commission on State Mandates (CSM) determines the bill’s requirements to be a reimbursable state mandate, the state would need to reimburse these costs to local educational agencies or provide funding through the K-12 Mandate Block Grant. State law requiring schools to provide free menstrual products recently was determined by the CSM to be a state mandated cost and the cost of the mandate was added to the K-12 Mandate Block Grant. Ongoing General Fund costs of an unknown amount, potentially in the low tens of millions of dollars, for FPACT programs to provide coverage for immunization against HPV to certain individuals. Costs would ultimately depend on the number of individuals accessing the benefit. If FPACT programs applied to the federal Vaccines for Children program, these costs would be largely offset by a 90% federal match.”
SUPPORT: (Verified 9/8/23)
Adolescent Health Working Group (co-source)
Black Women for Wellness Action Project (co-source)
Citizens for Choice (co-source)
Essential Access Health (co-source)
Generation Up (co-source)
Unite for Reproductive & Gender Equity (co-source)
Access Reproductive Justice
ACLU California Action
ACT for Women and Girls
Aids Healthcare Foundation
Alameda County Board of Supervisors
American College of Obstetricians and Gynecologists District IX
California Academy of Family Physicians
California Coalition for Youth
California Faculty Association
California Federation of Teachers
California Health+AdvocatesCalifornia Nurse Midwives Association
California School-Based Health Alliance
California Teachers Association
California Transgender Advisory Council - Office of Lieutenant Governor
California Women's Law Center
Capslo the Center for Health & Prevention
Coachman Moore and Associates
Community Clinic Association of Los Angeles County
DPA Health
Feminist Majority Foundation
Genders & Sexualities Alliance Network
GLIDE
Los Angeles LGBT Center
NARAL Pro-choice California
National Center for Youth Law
National Harm Reduction Coalition
National Health Law Program
Planned Parenthood Affiliates of California
Radiant Health Centers
Rainbow Pride Youth Alliance
Realistic Education in Action Coalition to Foster Health
San Francisco Aids Foundation
The Los Angeles Trust for Children's Health
Training in Early Abortion for Comprehensive Health Care
UCLA Bixby Center on Population and Reproductive Health
Women's Foundation of California, Dr. Beatriz Maria Solis Policy Institute
Women's Health Specialists
OPPOSITION: (Verified 9/8/23)
California Family Council
California Policy Center
ARGUMENTS IN SUPPORT: According to the California School-Based Health Alliance writes, "More than 325,000 Californians were infected with syphilis, chlamydia, or gonorrhea in 2019. Young people, and in particular youth of color, are disproportionately impacted. Statewide data indicate over half of all STIs in the state are experienced among California youth ages 15 – 24 years old. Young people in this age group make up more than five out of every 10 chlamydia cases in California, and more than 87% are youth of color. Condoms are an effective tool to reduce STI transmission, but condom use among sexually active teens has declined over the last decade. The CDC's Youth Risk Behavior Surveillance System shows that in 2019, an average of 20% of California high school students were sexually active and 47% of those students did not use condoms during their last sexual intercourse. Teens have long reported facing multiple barriers to accessing condoms that deter them from seeking and securing the resources they need to protect themselves against STIs and unintended pregnancy. When barriers remain, youth with low-incomes are often left without the option to regularly utilize condoms to help protect their health and prevent an unintended pregnancy from occurring.”
ARGUMENTS IN OPPOSITION: According to the California Family Council writes, " For the last decade or more this legislative body has been pushing condoms as the solution to sexually transmitted infections spreading among our youth. As the STI infection rate continued to rise, so did the insistence on easier access to condoms and information about safe sex at younger and younger ages. This was the whole argument surrounding the CA Healthy Youth Act passed in 2015, which mandates comprehensive sex education in every school district. Now in 2023, we have an STI epidemic on our hands. According to the California Department of Public Health, STIs are at epidemic levels. A 2020 report showed a 320% increase in syphilis over the past 10 years. Gonorrhea is up 190 percent. Despite these numbers, you still insist telling kids condoms will protect them. Why? Did you know condoms don't protect people from STIs such as herpes, genital warts, syphilis, and monkeypox, which can spread by skin-to-skin contact? Don't you think it is time to tell young people the truth, that those with the most fulfilling and healthy sex lives are those who treat sex as a special and intimate act to be shared in an opposite-sex, monogamous marriage? STIs can only thrive in a hook-up culture where sex is meaningless and done for fun with multiple partners. Handing out free condoms perpetuates such a culture. Please consider different options."
ASSEMBLY FLOOR: 65-11, 9/7/23
AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Connolly, Davies, Mike Fong, Friedman, Gabriel, Garcia, Gipson, Grayson, Haney, Hart, Holden, Irwin, Jackson, Jones-Sawyer, Kalra, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Luz Rivas, Rodriguez, Blanca Rubio, Santiago, Schiavo, Soria, Ting, Valencia, Villapudua, Waldron, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas
NOES: Megan Dahle, Dixon, Flora, Vince Fong, Gallagher, Lackey, Mathis, Jim Patterson, Joe Patterson, Sanchez, Ta
NO VOTE RECORDED: Chen, Essayli, Hoover, Wallis
Prepared by: Kordell Hampton / ED. / (916) 651-4105
9/9/23 9:01:28
**** END ****
SENATE THIRD READING
STR Bill Id:SB 541
Author:(Menjivar)
As Amended Ver:September 1, 2023
Majority vote
SUMMARY
Requires all public high schools to make condoms available to students by the start of the 2024-25 school year, and requires schools to provide information to students on the availability of condoms, as well as other sexual health information. Prohibits public schools from preventing distribution of condoms or preventing a school-based health center from making condoms available and easily accessible to students at the school-based health center site. Prohibits retailers from restricting sales of nonprescription contraception on the basis of age.
Major Provisions
- Requires, on or before the start of the 2024–25 school year, each public school to make condoms available to all pupils in grades nine to 12, inclusive, free of charge, and requires related information to be made available to students.
- Requires each public school serving any of grades seven to 12, inclusive, to allow condoms to be made available during the course of, or in connection with, educational or public health programs and initiatives, as specified.
- Requires public schools, serving any of grades seven to 12, to allow a school-based health center to make internal and external condoms available and easily accessible to pupils at the school-based health center site.
- Prohibits a retail establishment from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age, unless the contraception is otherwise subject to restriction on the basis of age. Specifies that penalties do not apply for non-compliance.
COMMENTS
Access to condoms by adolescents. The external condom remains the most popular contraceptive method among adolescents. Data from the Centers for Disease Control and Prevention (CDC)'s 2017 Youth Risk Behavior Surveillance (YRBS) reported that while overall sexual activity decreased among high school students, barrier method use (referred to as condom use in the YRBS) also declined among sexually active adolescents. Among sexually active high school students, 54% reported condom use during their last sexual encounter, a decline from 62% in 2007. Among 12th-grade students, 57% reported ever being sexually active, but they had the lowest use of condoms among all grades. (Grubb, 2020)
Condoms are available over the counter in all states but may be difficult for teens to access as many stores stock condoms in inaccessible locations that require a store attendant to assist the customer. The costs of condoms may also be a limiting factor for many young people. This bill would address the availability and affordability of condom use for teens by making these items accessible at no cost in schools. The bill also prohibits retail establishments from refusing to furnish nonprescription contraception solely on the basis of age.
In 2017, the Society for Adolescent Health and Medicine published a position statement, "Condom Availability in Schools: A Practical Approach to the Prevention of Sexually Transmitted Infection/HIV and Unintended Pregnancy," recommending increased barrier method availability at schools. Studies have found that school condom programs do not increase sexual activity, the number of sexual partners, or risk behaviors. (Grubb, 2020)
According to the Author
"By requiring free condoms in all California high schools, we are empowering the youth who decide to become sexually active to protect themselves and their partners from sexually transmitted infections (STIs), while also removing barriers that potentially shame them and lead to unsafe sex. Further, requiring the Family PACT program to cover human papillomavirus (HPV) vaccinations for ages 12-18 will decrease instances of patients delaying vaccination or becoming discouraged after being turned away. These programs can instill safe sexual habits among youth, protecting themselves now and into adulthood."
Arguments in Support
The California School-Based Health Alliance writes, "More than 325,000 Californians were infected with syphilis, chlamydia, or gonorrhea in 2019. Young people, and in particular youth of color, are disproportionately impacted. Statewide data indicate over half of all STIs in the state are experienced among California youth ages 15 – 24 years old. Young people in this age group make up more than five out of every 10 chlamydia cases in California, and more than 87% are youth of color.
Condoms are an effective tool to reduce STI transmission, but condom use among sexually active teens has declined over the last decade. The CDC's Youth Risk Behavior Surveillance System shows that in 2019, an average of 20% of California high school students were sexually active and 47% of those students did not use condoms during their last sexual intercourse. Teens have long reported facing multiple barriers to accessing condoms that deter them from seeking and securing the resources they need to protect themselves against STIs and unintended pregnancy. When barriers remain, youth with low-incomes are often left without the option to regularly utilize condoms to help protect their health and prevent an unintended pregnancy from occurring.
Some California high schools distribute free condoms to students, including schools in the Los Angeles and San Francisco Unified School Districts, in an effort to curb STI rates and reduce unintended pregnancy. However, not all schools do so, leaving youth in other regions – including regions with some of the highest rates of STIs and pregnancies among youth – without equitable access to condoms and preventive health resources. California youth need and deserve equitable access to condoms to protect their health and safety. The scope of the STI epidemic requires bold action. To reduce public health disparities, we must ensure that California youth have equitable access to condoms and the HPV vaccine."
Arguments in Opposition
The California Family Council writes, " For the last decade or more this legislative body has been pushing condoms as the solution to sexually transmitted infections spreading among our youth. As the STI infection rate continued to rise, so did the insistence on easier access to condoms and information about safe sex at younger and younger ages. This was the whole argument surrounding the CA Healthy Youth Act passed in 2015, which mandates comprehensive sex education in every school district. Now in 2023, we have an STI epidemic on our hands.
According to the California Department of Public Health, STIs are at epidemic levels. A 2020 report showed a 320% increase in syphilis over the past 10 years. Gonorrhea is up 190 percent. Despite these numbers, you still insist telling kids condoms will protect them. Why? Did you know condoms don't protect people from STIs such as herpes, genital warts, syphilis, and monkeypox, which can spread by skin-to-skin contact?
Don't you think it is time to tell young people the truth, that those with the most fulfilling and healthy sex lives are those who treat sex as a special and intimate act to be shared in an opposite-sex, monogamous marriage? STIs can only thrive in a hook-up culture where sex is meaningless and done for fun with multiple partners. Handing out free condoms perpetuates such a culture. Please consider different options."
FISCAL COMMENTS
According to the Assembly Appropriations Committee, ongoing Proposition 98 General Fund costs, of an unknown amount but potentially in the low millions of dollar annually, to schools to purchase condoms and inform students of the condoms' availability annually. Costs ultimately would depend on how many condoms schools make available.
VOTES
SENATE FLOOR: 31-8-1
YES: Allen, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dodd, Durazo, Eggman, Glazer, Gonzalez, Hurtado, Laird, Limón, McGuire, Menjivar, Min, Newman, Padilla, Portantino, Roth, Rubio, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener
NO: Alvarado-Gil, Dahle, Jones, Nguyen, Niello, Ochoa Bogh, Seyarto, Wilk
ABS, ABST OR NV: Grove
ASM EDUCATION: 5-1-1
YES: Muratsuchi, Juan Carrillo, Lee, McCarty, Quirk-Silva
NO: Megan Dahle
ABS, ABST OR NV: Hoover
ASM HEALTH: 12-3-0
YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner, Wendy Carrillo, Maienschein, McCarty, Rodriguez, Santiago, Villapudua, Weber
NO: Flora, Vince Fong, Joe Patterson
ASM APPROPRIATIONS: 11-4-1
YES: Holden, Bryan, Calderon, Wendy Carrillo, Mike Fong, Hart, Lowenthal, Papan, Pellerin, Weber, Wilson
NO: Megan Dahle, Dixon, Mathis, Sanchez
ABS, ABST OR NV: Soria
SENATE FLOOR: 40-0-0
YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
SENATE FLOOR: 31-9-0
YES: Allen, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dodd, Durazo, Eggman, Glazer, Gonzalez, Hurtado, Laird, Limón, McGuire, Menjivar, Min, Newman, Padilla, Portantino, Roth, Rubio, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener
NO: Alvarado-Gil, Dahle, Grove, Jones, Nguyen, Niello, Ochoa Bogh, Seyarto, Wilk
UPDATED
VERSION: September 1, 2023
CONSULTANT: Debbie Look / ED. / (916) 319-2087 FN: 0001571
Date of Hearing: August 23, 2023
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Chris Holden, Chair
SBPCA Bill Id:SB 541
Author:(Menjivar) – As Amended Ver:June 30, 2023
Policy Committee: | Education | Vote: | 5 - 1 |
Health | 12 - 3 | ||
|
|
Urgency: No State Mandated Local Program: Yes Reimbursable: Yes
SUMMARY:
This bill requires schools to make condoms available free of charge to all students in grades nine through 12. The bill also bill prohibits retailers from requiring customers to present proof of age to purchase condoms. Lastly, the bill requires the Family Planning Access Care Treatment (FPACT) program to provide coverage for immunization against human papilloma virus (HPV) to persons 18 years of age or younger.
Specifically, this bill:
- Requires, by the start of the 2024-25 school year, each public school to make internal and external condoms available to all pupils in grades nine to 12 free of charge. The bill requires schools to place condoms at a minimum of two locations on school grounds where the condoms are easily accessible to pupils during school hours without requiring assistance or permission from school staff. The bill requires condoms placed in locations not regularly supervised by school staff to be stored in tamper-proof dispensers.
- Requires these public schools to inform students through existing school communication channels that free condoms are available and where the condoms can be obtained on school grounds at the beginning of each school year. The bill also requires a public school to post at least one notice regarding these requirements. The notice also must include other information, including the contact information for a designated individual responsible for maintaining the requisite supply of condoms and information about how to use condoms properly.
- Requires each public school serving any of grades seven to 12 to allow the distribution of condoms during the course of, or in connection with, educational or public health programs and initiatives. The bill also prohibits a school maintaining any combination of classrooms from grades seven to 12 from prohibiting a school-based health center from making internal and external condoms available and easily accessible to students at the school-based health center site.
- Prohibits a retail establishment from refusing to furnish nonprescription contraception to a person solely on the basis of their age by means of any conduct, including requiring the customer to present identification for purposes of demonstrating their age.
- Requires FPACT programs that are not enrolled in the federally funded Vaccines for Children Program to provide coverage for HPV vaccinations to persons between 12 and 18.
FISCAL EFFECT:
- Ongoing Proposition 98 General Fund costs, of an unknown amount but potentially in the low millions of dollar annually, to schools to purchase condoms and inform students of the condoms’ availability annually. One-time costs, of an unknown amount, to buy and install tamper-proof dispensers in certain situations and to post a notice with certain information. Costs ultimately would depend on how many condoms schools make available and the number of schools installing tamper-proof dispensers.
According to the California Department of Education, 1.9 million students enrolled in grades nine through 12 in over 4,000 schools in the 2022-23 school year. According to Planned Parenthood, external condoms usually cost less than $1 each if bought in packs of 12 or more on the private market. Internal condoms cost significantly more. The California Department of Public Health (CDPH) provides discounted rates to certain entities of external condoms, which are $100 per 1,000, and internal condoms, which are $730 per 500. Tamper-proof condom dispensers tend to cost in the low hundreds of dollars each. If each school serving students in grades nine through 12 provided 1,000 external condoms and 500 internal condoms at the CDPH rates, and one tamper-proof dispenser, costs would total $4 million statewide. Costs could be less or more depending on the number of condoms provided, the cost of those condoms, and the locations of those condoms.
If the Commission on State Mandates (CSM) determines the bill’s requirements to be a reimbursable state mandate, the state would need to reimburse these costs to local educational agencies or provide funding through the K-12 Mandate Block Grant. State law requiring schools to provide free menstrual products recently was determined by the CSM to be a state mandated cost and the cost of the mandate was added to the K-12 Mandate Block Grant.
- Ongoing General Fund costs of an unknown amount, potentially in the low tens of millions of dollars, for FPACT programs to provide coverage for immunization against HPV to certain individuals. Costs would ultimately depend on the number of individuals accessing the benefit. If FPACT programs applied to the federal Vaccines for Children program, these costs would be largely offset by a 90% federal match.
COMMENTS:
- Purpose. According to the author:
By requiring free condoms in all California high schools, we are empowering the youth who decide to become sexually active to protect themselves and their partners from sexually transmitted infections (STIs), while also removing barriers that potentially shame them and lead to unsafe sex. Further, requiring the Family PACT program to cover HPV vaccinations for ages 12-18 will decrease instances of patients delaying vaccination or becoming discouraged after being turned away. These programs can instill safe sexual habits among youth, protecting themselves now and into adulthood.
- Background.
Sexual Health Education. AB 329 (Weber), Chapter 398, Statutes of 2016, required local educational agencies to provide comprehensive sexual health education and HIV prevention education to all students at least once in middle school and at least once in high school. Parents may opt their child out of a portion, or all, of the instruction and schools are required to notify parents of this right.
HPV Vaccines. The Center for Disease Control recommends all children between 11 and 12 years old should get two shots of the HPV vaccine six to 12 months apart. Teens and young adults who start the series later, between 15 and 26 years old, need three doses of the HPV vaccine.
FPACT is a program that provides comprehensive clinical family planning and family planning-related services, including office visits, procedures, and contraceptives, to qualified individuals with incomes below 200% federal poverty line.
The 2022 Budget Act expanded coverage of the HPV vaccine to FPACTs. However, the expansion only applied to patients 19 and older. The rationale for not providing the benefit to younger patients is that younger patients may already obtain the HPV vaccine through the federal “Vaccines for Children” program. However, about 10% of FPACTs, including some clinics like Planned Parenthood, do not participate in the Vaccines for Children program, typically due to burdensome program requirements.
This bill would require all FPACTs to cover HPV vaccines for patients age 12 to 18.
- Related Legislation. AB 659 (Aguiar-Curry) implements the same FPACT coverage provision as this bill, among other provisions. AB 659 is pending in the Senate Appropriations Committee.
- Prior Legislation. AB 367 (C. Garcia), Chapter 664, Statutes of 2021, requires all public schools serving students in grades six to 12 to stock specified restrooms with an adequate supply of free menstrual products, commencing in the 2022-23 school year.
Analysis Prepared by: Natasha Collins / APPR. / (916) 319-2081
Date of Hearing: July 11, 2023
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
SBPCA Bill Id:SB 541
Author:(Menjivar) – As Amended Ver:June 30, 2023
SENATE VOTE: 31-9
SUBJECT: Sexual health: contraceptives: immunization.
SUMMARY: Adds immunization against human papillomavirus (HPV), as clinically indicated, to persons who are between 12 and 18 years of age, inclusive, as a covered benefit in the Family Planning, Access, Care, and Treatment (Family PACT) Program for provider sites not enrolled in the federal Vaccines for Children (VFC) program. Requires all public high schools to make condoms available to students by the start of the 2024-25 school year, and requires schools to provide information to students on the availability of condoms, as well as other sexual health information. Prohibits public schools from preventing distribution of condoms or preventing a school-based health center from making condoms available and easily accessible to students at the school-based health center site. Prohibits retailers from restricting sales of nonprescription contraception on the basis of age. Specifically, this bill:
- Adds coverage for immunization against HPV, as clinically indicated, to persons between 12 and 18 years of age, inclusive, at Family PACT provider sites that are not enrolled in the federally funded VFC program administered by the federal Centers for Disease Control and Prevention (CDC), and specifies the Department of Health Care Services (DHCS) is not prohibited from providing that coverage to persons who are over 18 years of age through the Family PACT Program.
- Requires, on or before the start of the 2024–25 school year, each public school to make condoms available to all pupils in grades 9 to 12, inclusive, free of charge, and requires related information to be made available to students.
- Requires each public school serving any of grades 7 to 12, inclusive, to allow the distribution of condoms during the course of, or in connection with, educational or public health programs and initiatives, as specified.
- Requires public schools, serving any of grades 7 to 12, to allow a school-based health center to make internal and external condoms available and easily accessible to pupils at the school-based health center site.
- Prohibits a retail establishment from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age, unless the contraception is otherwise subject to restriction on the basis of age. Specifies that penalties do not apply for non-compliance.
- Provides, if the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs will be made pursuant to existing law.
EXISTING LAW:
- Establishes the Family PACT program, administered by DHCS, which provides comprehensive clinical family planning services, including family planning, contraceptive drugs and devices, health education and counseling, treatment of specified conditions, and other family-planning related services, to qualified individuals with incomes below 200% of the federal poverty level (FPL). [Welfare and Institutions Code § 14132 (aa)]
- Establishes the California Healthy Youth Act to provide pupils with the knowledge and skills necessary to protect their sexual and reproductive health from HIV and other sexually transmitted infections and from unintended pregnancy, and, among other things, to ensure that pupils receive integrated, comprehensive, accurate, and unbiased sexual health and HIV prevention instruction, and provide educators with clear tools and guidance to accomplish that objective. [Education Code (EC) § 51930]
- Requires each school district to ensure that all students in grades 7 to 12 receive comprehensive sexual health education and HIV prevention at least once in junior high or middle school and once in high school. Requires this instruction to include information about the value of delaying sexual activity while also providing medically accurate information on other methods of preventing HIV and other sexually transmitted infections and pregnancy, as well as information about the effectiveness and safety of all FDA-approved contraceptive methods in preventing pregnancy, including, but not limited to, emergency contraception. [EC § 51934]
- Requires local educational agencies (LEAs), at the beginning of each school year, or, for a pupil who enrolls in a school after the beginning of the school year, at the time of that pupil’s enrollment, to provide parents and guardians with a notice explaining planned instruction in comprehensive sexual health education and HIV prevention education, and requires LEAs to advise parents and guardians of their rights to excuse their child from the instruction. [EC § 51938]
FISCAL EFFECT: According to the Senate Appropriations Committee:
- By requiring schools to provide condoms for free to students in grades 9 through 12, this bill could result in a reimbursable state mandate. The magnitude of the costs is unknown but could be in the high hundreds of thousands to low millions of dollars in Proposition 98 General Fund each year. To the extent that school districts elect not to file mandate claims for these activities, this could place additional cost pressure on the K-12 Mandate Block Grant.
- This bill’s requirement to provide coverage for immunization against HPV could result in increased program costs potentially in the low tens of millions of dollars each year. A precise amount will largely depend on the actual take up rate of eligible Medi-Cal recipients.
- The Department of Public Health (DPH) indicates that any costs to DPH related to the bill’s prohibition on retail establishments would be minor and absorbable within existing resources.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, many young people rely on the state’s family planning program, Family PACT, to obtain free and confidential family planning and related services including sexually transmitted infection (STI) counseling, testing and treatment. The author notes the program served more than 85,000 teens in 2019 alone. The author indicates Family PACT began covering the HPV vaccine in 2022 when the expanded benefit was included in the 2022 Budget Act; however, the policy fell short in extending the HPV vaccine benefit only for patients 19 and older. The author states that while the rationale for the age limit was that minors can obtain the vaccine from the VFC program, in reality, not all family planning providers are VFC providers, cutting off access for teens in a place that may be their trusted source of health care. The author indicates thousands of teens may be unable to get a potentially life-saving vaccine while getting other sexual and reproductive health services in a confidential and non-judgmental health care setting, negatively affecting their continuity of care and unnecessarily denying them access to a potentially life-saving vaccine. The author explains this bill would close the HPV coverage gap by requiring the Family PACT program to cover the HPV vaccine for teens ages 12 to 18 at Family PACT provider sites that are not enrolled in the VFC program.
- BACKGROUND.
- Family PACT. Family PACT provides comprehensive clinical family planning and family planning-related services to qualified individuals with incomes below 200% FPL. According to DHCS, Family PACT is designed to narrow the gap between insured and uninsured individuals in California. The program is designed to make contraception easily accessible to individuals who qualify. Unlike other programs with more complex and lengthy eligibility processes, enrolled Family PACT providers can determine an individual’s eligibility for Family PACT at the site of clinical service delivery, on the same day the individual seeks services. Family PACT covers a wide range of family planning services, including office visits, procedures, drugs and contraceptive supplies.
- HPV. According to the CDC, HPV vaccine protects against cancers caused by HPV infection. HPV is a common virus that infects teens and adults. About 1 million people, including teens, become infected with HPV each year. HPV infection can cause cervical, vaginal, and vulvar cancers in women and penile cancer in men. HPV can also cause anal cancer, cancer of the back of the throat (oropharynx), and genital warts in both men and women. Annually, 36,500 people are estimated to be diagnosed with a cancer caused by HPV infection. CDC estimates HPV vaccination could prevent more than 90% of cancers caused by HPV from ever developing.
CDC recommends all children who are 11 or 12 years old should get two shots of HPV vaccine 6 to 12 months apart. CDC explains vaccinated during this time protects preteens before ever being exposed to the virus through intimate sexual contact. Teens and young adults who start the series later, at ages 15 through 26 years, need three doses of HPV vaccine. Vaccination is not recommended for everyone older than age 26 years. CDC notes some adults age 27 through 45 years who are not already vaccinated may decide to get HPV vaccine after speaking with their doctor about their risk for new HPV infections and the possible benefits of vaccination for them. HPV vaccination in this age range provides less benefit on a population level, because more people in this age range have already been exposed to HPV. - VFC. The federally funded VFC program provides no-cost vaccines for children ages 18 years and younger who are uninsured, Medicaid-eligible, American Indian or Alaska Native. Any health care provider authorized by their state to prescribe vaccines can be a VFC provider. VFC providers agree to order and provide all age-appropriate, federally recommended vaccines to VFC-eligible patient populations. In exchange for federally funded vaccines, enrolled providers agree to partner with the VFC Program to ensure that program requirements are met. There are a number of administrative steps related to becoming a VFC provider and maintaining enrollment. Providers must enroll and recertify each year, and receive periodic visits by VFC field representatives who conduct scheduled compliance visits and unannounced storage and handling visits to assess the provider’s compliance with CDC’s standards. Providers agree to various tracking, vaccine storage and handling, staff training, and other compliance requirements in exchange for receiving free pediatric vaccines. VFC also requires providers to identify a Vaccine Coordinator, an on-site employee who is fully trained and responsible for implementing and overseeing the provider’s vaccine management plan, as well as a backup Vaccine Coordinator.
According to the bill’s sponsors, many family planning clinics where teens seek care funded through Family PACT are not VFC providers. Proponents of this bill indicate it seeks to offer a “no wrong door” approach to receiving these important vaccines. - Condoms in Schools. While sexuality is a normal part of adolescent development, sexual activity among teens can have serious consequences, including STIs and unintended pregnancy. It is estimated that although young people ages 15-24 make up 13% of the U.S. population, they represent around 25% of the sexually active population and account for around 50% of all new STI cases each year. The external condom remains the most popular contraceptive method among adolescents. Condoms are available over the counter in all states but may be difficult for teens to access, as some stores stock condoms in inaccessible locations that require a store attendant to assist the customer. The costs of condoms may also be a limiting factor for many young people. This bill would require condoms to be provided in all California high schools in order to protect teens from STIs while also removing barriers that lead to lack of access to condoms.
- SUPPORT. The sponsors of this bill write that vaccination rates against HPV are down nationwide due to the COVID-19 pandemic, putting teens and young people at risk of developing HPV-related cancers later in life. The sponsors indicate many young people rely on the state’s family planning program, Family PACT, to obtain free and confidential family planning and related services including STI counseling, testing and treatment, but that the HPV coverage policy in Family PACT is inadequate in that it excludes teens, with the rationale that minors can obtain the vaccine from the VFC program. The sponsors note that while there are more than 2,000 Family PACT health providers, not all of them are VFC providers and don’t have the ability to provide the HPV vaccine to minors. Therefore, the sponsors argue, this policy leaves thousands of teens unable to get a potentially life-saving vaccine while getting other sexual and reproductive health services, unnecessarily denying them access to the vaccine.
- OPPOSITION. California Family Council and California Policy Center oppose this bill, citing concerns related to the provision of condoms in public school. California Family Council questions the efficacy of condoms for preventing sexually transmitted infections and asserts handing out free condoms perpetuates a “hook-up culture.” California Policy Center argues that providing birth control is not a core mission of public education, and that this bill is a distraction that diverts money and focus from the core mission of promoting literacy.
- RELATED LEGISLATION. AB 659 (Aguiar-Curry) states that it is the public policy of the state that pupils are expected to be fully immunized against HPV before admission or advancement to the eighth grade, and before first-time enrollment in any public college or university; and requires health plans, insurers, and Family PACT to provide coverage for the HPV vaccine. AB 659 is pending in the Senate Education Committee.
- PREVIOUS LEGISLATION. AB 2312 (Lee) of 2022 would have prohibited retailers from restricting sales of nonprescription contraception on the basis of age, subjecting retailers to a civil penalty for violations. AB 2312 was referred to the Assembly Health Committee, but the hearing was canceled at the request of the author.
AB 2516 (Aguiar-Curry) of 2022 would have required Family PACT, health plans, and insurers to provide coverage for the HPV vaccine. AB 2516 was vetoed by the Governor, who stated, in part, that the HPV vaccine is available through Medi-Cal and the VFC programs. As a result, the Governor stated, providing the HPV vaccine to teens in the Family PACT program to individuals who are already covered through the VFC program would result in millions of dollars in General Fund expenditures not included in 2022 Budget Act and would not be available for federal reimbursement. The Governor noted the 2022 Budget Act included $8 million ($4.6 million General Fund) to add the HPV vaccine under the Family PACT program for individuals ages 19 through 45, and that while he supports the author’s efforts to address STI prevention, proposals with an ongoing fiscal impact should be considered through the annual budget process. - DOULBE REFERRAL. This bill is double referred; it passed the Assembly Education Committee by a vote of 5-1 on June 28, 2023.
- POLICY COMMENTS. This bill has a substantive conflict with a provision of AB 659 that specifies “comprehensive clinical family planning services” covered by Family PACT include the HPV vaccine for persons for whom it is approved by the FDA. This would include those under 18, the same population targeted by this bill. As this bill moves forward, the Committee recommends the author continue working in collaboration with AB 659’s author to resolve the conflict.
In addition, this bill does not address the Governor’s veto of a similar measure last year (AB 2516). Accordingly, the author may also wish to explore potential alternative solutions to address the goals of ensuring access to HPV vaccines in family planning clinics, such as addressing barriers to more robust enrollment of family planning providers in the VFC program.
REGISTERED SUPPORT / OPPOSITION:
Support
Access Reproductive Justice
ACLU California Action
ACT for Women and Girls
Adolescent Health Working Group
AIDS Healthcare Foundation
Alameda County Board of Supervisors
American College of Obstetricians and Gynecologists, District IX
Black Women for Wellness Action Project
California Academy of Family Physicians
California Coalition for Youth
California Faculty Association
California Federation of Teachers
California Health+ Advocates, Subsidiary of The California Primary Care Association
California Nurse Midwives Association
California School-Based Health Alliance
California Teachers Association
California Women's Law Center
CAPSLO, the Center for Health & Prevention
Citizens for Choice
Coachman Moore and Associates
Community Clinic Association of Los Angeles County
Desert Aids Project D/b/a DAP Health
Essential Access Health
Feminist Majority Foundation
Genders & Sexualities Alliance Network
Generation Up
Glide
Los Angeles LGBT Center
Naral Pro-Choice California
National Center for Youth Law
National Harm Reduction Coalition
National Health Law Program
Planned Parenthood Affiliates of California
Radiant Health Centers
Rainbow Pride Youth Alliance
Realistic Education in Action Coalition to Foster Health (REACH LA)
San Francisco AIDS Foundation
The Los Angeles Trust for Children's Health
Training in Early Abortion for Comprehensive Health Care
UCLA Bixby Center on Population and Reproductive Health
URGE: Unite for Reproductive & Gender Equity
Women's Foundation of California
Women's Health Specialists
Opposition
California Family Council
California Policy Center
Analysis Prepared by: Lisa Murawski / HEALTH / (916) 319-2097
Date of Hearing: June 28, 2023
ASSEMBLY COMMITTEE ON EDUCATION
Al Muratsuchi, Chair
SBPCA Bill Id:SB 541
Author:(Menjivar) – As Amended Ver:May 18, 2023
[Note: This bill is double referred to the Assembly Health Committee and will be heard by that Committee as it relates to issues under its jurisdiction.]
SENATE VOTE: 31-9
SUBJECT: Sexual health: contraceptives: immunization
SUMMARY: Requires all public high schools to make condoms available to students by the start of the 2024-25 school year, and to provide information to students on the availability of condoms, as well as other sexual health information. Prohibits public schools from preventing a school-based health center from making condoms available and easily accessible to students at the school-based health center site. Specifically, this bill:
- Requires each public school serving students in grades 9 to 12 to make internal and external condoms available to all students free of charge by the start of the 2024-25 school year to prevent and reduce unintended pregnancies and sexually transmitted infections.
- Requires schools to place condoms in a minimum of two locations on school grounds where they are easily accessible to students during school hours without requiring assistance or permission from school staff, and requires that condoms placed in locations not regularly supervised by school staff be stored in tamper-proof dispensers.
- Requires public schools to inform students at the beginning of each school year, through regular school communication channels, that free condoms are available and where the condoms can be obtained.
- Requires public schools to prominently post at least one notice regarding the availability of free condoms in appropriate areas that are accessible to, and commonly frequented by, students, and requires the notice to include all of the following:
- The text of this section;
- The contact information, including an email address and telephone number, for a designated individual responsible for maintaining the supply of condoms;
- Information that abstinence from sexual activity and injection drug use is the only certain way to prevent HIV and other sexually transmitted infections and that abstinence from sexual intercourse is the only certain way to prevent unintended pregnancy;
- Information directing pupils to where they can find information about how to use condoms properly; and
- Information on how to access local resources and pupils’ legal rights to access local resources for sexual and reproductive health care such as testing and medical care for HIV and other sexually transmitted infections and pregnancy prevention and care, as well as local resources for assistance with sexual assault and intimate partner violence.
- Requires public schools serving students in grades 7 to 12 to allow the distribution of condoms during the course of educational or public health programs and initiatives, including any of the following:
- Community organizations or other entities providing instruction on the California Healthy Youth Act;
- Pupil peer health programs, clubs, or groups;
- Pupil health fairs conducted on campus; and
- School-based health center staff.
- Authorizes a state agency, the California Department of Education (CDE), or a public school to accept gifts, grants, and donations from any source for the support of a public school carrying out the provisions of this section, including, but not limited to, the acceptance of condoms from a manufacturer or wholesaler.
- Encourages public schools to explore partnerships with local health jurisdictions, community health centers, nonprofit organizations, and the State Department of Public Health (CDPH) to comply with these requirements.
- Prohibits a public school serving students in grades 7 to 12, a school district, the CDE, or a county office of education (COE), from preventing a school-based health center from making internal and external condoms available and easily accessible to pupils at the school-based health center site.
- Defines “public school” to include a school operated by a school district, COE, or a charter school.
- Defines “school-based health center” as a center or program, located at or near a public school, that provides age-appropriate health care services at the program site or through referrals, and that may conduct routine physical, mental health, and oral health assessments, and provide referrals for any services not offered onsite. Includes a center or program that may serve two or more nonadjacent schools or local educational agencies (LEAs).
- Defines “local health jurisdiction” as a county health department or combined health department in the case of counties acting jointly or city health department.
- Requires the Family PACT program to provide coverage for immunization against human papilloma virus (HPV), as clinically indicated, to persons between 12 and 18 years of age.
- Prohibits a retail establishment from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age.
EXISTING LAW:
- Establishes the California Healthy Youth Act to provide pupils with the knowledge and skills necessary to protect their sexual and reproductive health from HIV and other sexually transmitted infections and from unintended pregnancy, and, among other things, to ensure that pupils receive integrated, comprehensive, accurate, and unbiased sexual health and HIV prevention instruction, and provide educators with clear tools and guidance to accomplish that objective. (Education Code (EC) 51930)
- Requires each school district to ensure that all students in grades 7 to 12 receive comprehensive sexual health education and HIV prevention at least once in junior high or middle school and once in high school. Requires this instruction to include information about the value of delaying sexual activity while also providing medically accurate information on other methods of preventing HIV and other sexually transmitted infections and pregnancy, as well as information about the effectiveness and safety of all FDA-approved contraceptive methods in preventing pregnancy, including, but not limited to, emergency contraception. (EC 51934)
- Requires LEAs, at the beginning of each school year, or, for a pupil who enrolls in a school after the beginning of the school year, at the time of that pupil’s enrollment, to provide parents and guardians with a notice:
- About instruction in comprehensive sexual health education and HIV prevention education and research on pupil health behaviors and risks planned for the coming year.
- Advising the parent or guardian that the educational materials used in sexual health education are available for inspection.
- Advising the parent or guardian whether the comprehensive sexual health education or HIV prevention education will be taught by school district personnel or by outside consultant, as provided.
- Advising the parent or guardian that the parent or guardian has the right to excuse their child from comprehensive sexual health education and HIV prevention education and that in order to excuse their child they must state their request in writing to the LEA. (EC 51938)
- Provides that the parent or guardian of a pupil has the right to excuse their child from all or part of that education, including related assessments, through a passive consent (“opt-out”) process and prohibits a school district from requiring active parental consent (“opt-in”) for sexual health education for pupils of any grade. (EC 51938)
FISCAL EFFECT: According to the Senate Appropriations Committee:
- By requiring schools to provide condoms for free to students in grades 9 through 12, this bill could result in a reimbursable state mandate. The magnitude of the costs is unknown but could be in the high hundreds of thousands to low millions of dollars in Proposition 98 General Fund each year. To the extent that school districts elect not to file mandate claims for these activities, this could place additional cost pressure on the K-12 Mandate Block Grant.
- The bill’s requirement to provide coverage for immunization against HPV could result in increased program costs potentially in the low tens of millions of dollars each year. A precise amount will largely depend on the actual take up rate of eligible Medi-Cal recipients.
- The Department of Public Health indicates that any costs to the department related to the bill’s prohibition on retail establishments would be minor and absorbable within existing resources.
COMMENTS:
Need for the bill. According to the author “By requiring free condoms in all California high schools, we are empowering the youth who decide to become sexually active to protect themselves and their partners from sexually transmitted infections (STIs), while also removing barriers that potentially shame them and lead to unsafe sex. Further, requiring the Family PACT program to cover human papillomavirus (HPV) vaccinations for ages 12-18 will decrease instances of patients delaying vaccination or becoming discouraged after being turned away. These programs can instill safe sexual habits among youth, protecting themselves now and into adulthood.”
California Healthy Youth Act. Beginning in 2016 with AB 329 (Weber) for the first time, required LEAs to provide comprehensive sexual health education and HIV prevention education to all students at least once in middle school and at least once in high school. Parents are afforded the right to opt their child out of a portion, or all, of the instruction and LEAs are required to notify parents and guardians of this right.
Sexual health of teens. Sexual health is a critical component of overall teen health. While sexuality is a normal part of adolescent development, sexual activity can have serious consequences, including STIs and unintended pregnancy. According to survey data for the 2017-2018 school year, an estimated 87% of California teens ages 14-17 had never had sex. Young people who engage in sexual activity may be at risk for sexually transmitted infections such as chlamydia and gonorrhea. In 2018, more than 48,000 new chlamydia and gonorrhea infections were reported among teens ages 15-19 statewide. (KidsData.org)
It is estimated that although young people ages 15-24 make up 13% of the U.S. population, they represent around 25% of the sexually active population and account for around 50% of all new STI cases each year. Among infectious diseases that must be reported to the U.S. government, chlamydia and gonorrhea are the most common, with young people ages 15-24 having the highest rates of infection when compared with other age groups. Nationwide, African American youth experience especially high rates of chlamydia and gonorrhea; in 2021, black youth ages 15-19 were diagnosed with chlamydia at more than five times the rate for white youth of the same age, and with gonorrhea at nearly 12 times the rate of their white peers. (KidsData.org)
Rates of teenage pregnancy have declined over time. The number of births per 1,000 women ages 15-19 in California has declined by 75% over the past 20 years from 89.6 in 1995 to 17.6 in 2016, as shown below. Despite these improvements, many counties continue to have high rates, with some exceeding 30 births per 1,000 teens in 2016. The majority of teen births statewide are to women ages 18-19, though rates have declined for all age groups.
Rates of Teen Births Per 1,000 women to youth ages 15-19 from 1995-2016
Source: KidsData.org
Despite the relatively low birth rates among teens overall, disparities exist along race/ethnicity lines, as Hispanic, African American, and American Indian/Alaska Native youth experience births at much higher rates than their White or Asian peers.
Race/ethnicity | Number of births per 1,000 women ages 15-19, by race/ethnicity |
African American | 17.6 |
American Indian/Alaska Native | 17.8 |
Asian/Pacific Islander | 2.5 |
Hispanic/Latina | 23.7 |
White | 6.2 |
Multiracial | 11.6 |
Research notes that adolescent births are associated with serious challenges and negative outcomes for parents, their children, and society overall. Teen mothers are more likely than mothers in their 20s and early 30s to have premature births, infants with low birthweight, and babies who die in infancy. Children of teens also are at increased risk for physical, behavioral, cognitive, and academic challenges later in life. Children born to teens are more likely to drop out of high school, enter the criminal justice system in adolescence, become teen parents themselves, and experience unemployment in adulthood, compared with children born to older mothers. (KidsData.org)
Access to condoms by adolescents. The external condom remains the most popular contraceptive method among adolescents. Data from the Centers for Disease Control and Prevention (CDC)’s 2017 Youth Risk Behavior Surveillance (YRBS) reported that while overall sexual activity decreased among high school students, barrier method use (referred to as condom use in the YRBS) also declined among sexually active adolescents. Among sexually active high school students, 54% reported condom use during their last sexual encounter, a decline from 62% in 2007. Among 12th-grade students, 57% reported ever being sexually active, but they had the lowest use of condoms among all grades. (Grubb, 2020)
Condoms are available over the counter in all states but may be difficult for teens to access as many stores stock condoms in inaccessible locations that require a store attendant to assist the customer. The costs of condoms may also be a limiting factor for many young people. This bill would address the availability and affordability of condom use for teens by making these items accessible at no cost in schools. The bill also prohibits retail establishments from refusing to furnish nonprescription contraception solely on the basis of age.
In 2017, the Society for Adolescent Health and Medicine published a position statement, “Condom Availability in Schools: A Practical Approach to the Prevention of Sexually Transmitted Infection/HIV and Unintended Pregnancy,” recommending increased barrier method availability at schools. Studies have found that school condom programs do not increase sexual activity, the number of sexual partners, or risk behaviors. (Grubb, 2020)
According to the author’s office, school in some regions across the state have been providing free condoms to students for decades, leaving teens in other regions – including regions with some of the highest rates of STIs and pregnancies among youth – without equitable access to condoms and preventive health care. Schools that distribute condoms do so by establishing partnerships to obtain condoms supplies. Both the Los Angeles Unified School District and San Francisco Unified School District established condom access programs in the 1990s at high schools with the support of funding from the CDC. Some county departments of public health and local health jurisdictions provide condoms to their local high schools, such as in the Long Beach Unified School District. At some high schools in the city of Fresno and other cities across California, campuses collaborate with community health centers, Planned Parenthood affiliates, or other community-based organizations to obtain condom supplies.
Recommended Committee Amendments. Staff recommend that the bill be amended as follows:
- Remove the requirement that the notice that schools must post regarding the availability of condoms at the schoolsite include the text of the Education Code section.
- Add state special schools to the definition of public schools.
Arguments in support. The California School-Based Health Alliance writes, “More than 325,000 Californians were infected with syphilis, chlamydia, or gonorrhea in 2019. Young people, and in particular youth of color, are disproportionately impacted. Statewide data indicate over half of all STIs in the state are experienced among California youth ages 15 – 24 years old. Young people in this age group make up more than 5 out of every 10 chlamydia cases in California, and more than 87% are youth of color.
Condoms are an effective tool to reduce STI transmission, but condom use among sexually active teens has declined over the last decade. The CDC’s Youth Risk Behavior Surveillance System shows that in 2019, an average of 20% of California high school students were sexually active and 47% of those students did not use condoms during their last sexual intercourse. Teens have long reported facing multiple barriers to accessing condoms that deter them from seeking and securing the resources they need to protect themselves against STIs and unintended pregnancy. When barriers remain, youth with low-incomes are often left without the option to regularly utilize condoms to help protect their health and prevent an unintended pregnancy from occurring.
Some California high schools distribute free condoms to students, including schools in the Los Angeles and San Francisco Unified School Districts, in an effort to curb STI rates and reduce unintended pregnancy. However, not all schools do so, leaving youth in other regions – including regions with some of the highest rates of STIs and pregnancies among youth – without equitable access to condoms and preventive health resources. California youth need and deserve equitable access to condoms to protect their health and safety. The scope of the STI epidemic requires bold action. To reduce public health disparities, we must ensure that California youth have equitable access to condoms and the HPV vaccine.”
Arguments in opposition. Two individuals express their opposition, but did not provide any details.
Related legislation. AB 659 (Aguiar-Curry) of the 2023-24 Session requires a health care service plan contract or a disability insurance policy to provide coverage without cost sharing for the HPV vaccine. Expands comprehensive clinical family planning services under the Family Planning, Access, Care, and Treatment Program to include the HPV vaccine. Specifies that it is the public policy of this state that: 1) pupils are expected to be fully immunized against HPV before admission or advancement to the 8th grade level of any private or public elementary or secondary school; and, 2) students who are 26 years of age or younger are expected to be fully immunized against HPV before first-time enrollment at an institution of the California State University (CSU), the University of California (UC), or the California Community Colleges (CCC). Requires, upon a pupil's admission or advancement to the 6th grade level, the governing authority to submit to the pupil and their parent or guardian a notification containing a statement about the state's public policy on HPV and advising that the pupil be fully immunized before admission or advancement to the 8th grade level.
AB 2482 (Calderon) Chapter 933, Statutes of 2022, establishes the Wellness Vending Machine Pilot Program, until July 1, 2029, that requires the CSU and the CCC to establish at five campuses of their perspective segments at least one vending machine that dispenses wellness products, including condoms. Additionally, this bill requests the UC to establish at any number of its campuses, at least one vending machine that dispenses wellness products.
AB 329 (Weber), Chapter 398, Statutes 2016, made instruction in sexual health education mandatory, revises HIV prevention education content, expands topics covered in sexual health education, requires this instruction to be inclusive of different sexual orientations, and clarifies parental consent policy.
AB 367 (C.Garcia), Chapter 664, Statutes of 2021, requires all public schools serving students in grades 6 to 12 to stock specified restrooms with an adequate supply of free menstrual products, commencing in the 2022-23 school year; and requires the CSU and the CCC, and encourages the Regents of the UC, independent institutions of higher education, and private postsecondary educational institutions, to stock an adequate supply of free menstrual products at no fewer than one designated and accessible central location on each campus.
REGISTERED SUPPORT / OPPOSITION:
Support
ACT for Women and Girls |
Adolescent Health Working Group |
Aids Healthcare Foundation |
Alameda County Board of Supervisors |
American College of Obstetricians and Gynecologists District Ix |
Black Women for Wellness Action Project |
California Coalition for Youth |
California Faculty Association |
California Health+advocates |
California Nurse Midwives Association |
California School-based Health Alliance |
California Teachers Association |
California Women's Law Center |
Capslo the Center for Health & Prevention |
Citizens for Choice |
Coachman Moore and Associates |
Community Clinic Association of Los Angeles County |
Desert Aids Project D/b/a Dap Health |
Essential Access Health |
Genders & Sexualities Alliance Network |
GenUp |
Glide |
Naral Pro-choice California |
National Center for Youth Law |
National Harm Reduction Coalition |
National Health Law Program |
Planned Parenthood Affiliates of California |
Radiant Health Centers |
Realistic Education in Action Coalition to Foster Health |
San Francisco Aids Foundation |
The Los Angeles Trust for Children's Health |
Training in Early Abortion for Comprehensive Health Care |
UCLA Bixby Center on Population and Reproductive Health |
Urge |
Women's Foundation California |
Women's Health Specialists |
Opposition
2 individuals
Analysis Prepared by: Debbie Look / ED. / (916) 319-2087
SENATE RULES COMMITTEEOffice of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 541 |
THIRD READING
Bill No: SB 541
Author: Menjivar (D), et al.
Amended: 5/18/23
Vote: 21
SENATE EDUCATION COMMITTEE: 5-2, 3/29/23
AYES: Newman, Cortese, Glazer, McGuire, Smallwood-Cuevas
NOES: Ochoa Bogh, Wilk
SENATE HEALTH COMMITTEE: 10-1, 4/12/23
AYES: Eggman, Glazer, Gonzalez, Hurtado, Limón, Menjivar, Roth, Rubio, Wahab, Wiener
NOES: Nguyen
NO VOTE RECORDED: Grove
SENATE APPROPRIATIONS COMMITTEE: 5-2, 5/18/23
AYES: Portantino, Ashby, Bradford, Wahab, Wiener
NOES: Jones, Seyarto
SUBJECT: Sexual health: contraceptives: immunization
SOURCE: Adolescent Health Working Group
Black Women for Wellness Action Project
Citizens for Choice
Essential Access Health
DIGEST:
This bill requires schools, on or before the start of the 2024-25 school year, to make internal and external condoms available for free to all students in grades 9 through 12. This bill also requires the existing Family Planning Access Care Treatment (PACT) program to provide coverage for immunization against human papilloma virus (HPV) to persons between 12 and 18 years of age or younger.
ANALYSIS:
Existing law:
- Establishes the California Healthy Youth Act (CHYA), which requires local educational agencies (LEAs) to provide comprehensive sexual health and HIV prevention instruction to all students in grades 7 to 12, at least once in middle school and once in high school. (EC § 51933)
- Authorizes an LEA to contract with outside consultants or guest speakers, including those who have developed multilingual curricula or curricula accessible to persons with disabilities, to deliver comprehensive sexual health education and HIV prevention education or to provide training for school district personnel. All outside consultants and guest speakers shall have expertise in comprehensive sexual health education and HIV prevention education and have knowledge of the most recent medically accurate research on the relevant topic or topics covered in their instruction. (EC § 51936)
- Requires that pupils in grades 7 to 12, inclusive, receive comprehensive sexual health education at least once in junior high or middle school and at least once in high school. (EC § 51934)
- Establishes the Department of Health Care Services (DHCS) to administer the Family PACT program, which provides comprehensive clinical family planning services to low income persons. (WIC §14132, et seq.)
This bill:
- Requires the Family PACT program to provide coverage for immunization against HPV, as clinically indicated, to persons who are between 12 and 18 years of age years of age or younger.
- Prohibits a retail establishment from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age.
- Requires public schools, on or before the start of the 2024–25 school year, to make internal and external condoms available free of charge to all pupils in grades 9 to 12, as specified.
- Requires public schools to inform pupils through existing communication channels that free condoms are available, and where the condoms can be obtained on school grounds, as specified. Requires schools to post at least one notice that includes, among other things, contact information for a designated individual responsible for maintaining the supply of condoms; information about abstinence from sexual activity and injection drug use being the only certain way to prevent HIV and other sexually transmitted infections (STIs), and that abstinence from sexual intercourse is the only certain way to prevent unintended pregnancy; information about how to use condoms properly; and, information on how to access local resources and pupils’ legal rights to access those resources for sexual and reproductive health care, as well as local resources for assistance with sexual assault and intimate partner violence.
- Requires public schools serving 7 to 12 grades to allow the distribution of condoms during the course of, or in connection with, educational or public health programs and initiatives, including, but not limited to, community organizations or other entities providing instruction for purposes of the California Healthy Youth; pupil peer health programs, clubs, or groups; pupil health fairs conducted on campus; or, school-based health center staff. Prohibits public schools serving any grades 7 to 12 from prohibiting a school-based health center from making condoms available and easily accessible to pupils.
- Permits state agencies or public schools to accept gifts, grants, and donations from any source for the support of a public school carrying out the provisions of this bill, as specified.
- Clarifies that a school can leverage government public health funding and community partnerships to obatin condoms for school campuses.
Comments
- Author’s statement. According to the author, the COVID-19 public health emergency exacerbated STI rates in California and across the country that were already skyrocketing to crisis levels prior to the pandemic. Nearly 350,000 Californians were infected with syphilis, chlamydia, or gonorrhea in 2019. California youth – teens and young adults of color in particular – are disproportionately impacted. Statewide data indicate over half of all STIs in the state are experienced among young people ages 15 to 24 years old. This bill seeks to address the STI epidemic among California youth and improve equitable public health outcomes statewide by expanding teen access to condoms and the HPV vaccine.
- California Healthy Youth Act. The CHYA took effect in 2003 and was initially known as the Comprehensive Sexual Health and HIV/AIDS Prevention Education Act. Originally, the act LEAs to provide comprehensive sexual health education in any grade, including kindergarten, so long as it consisted of age-appropriate instruction and used instructors trained in the appropriate courses. Beginning in 2016 with AB 329 (Weber, Chapter 398, Statutes of 2015), the act was renamed the CHYA and, for the first time, required LEAs, excluding charter schools, to provide comprehensive sexual health education and HIV prevention education to all students at least once in middle school and at least once in high school. Charter schools must also provide that same instruction. From its inception in 2003 through today, the CHYA has always afforded parents the right to opt their child out of a portion, or all, of the instruction and required LEAs to notify parents and guardians of this right. Parents and guardians can exercise this right by informing the LEA in writing of their decision.
- Comprehensive sexual health education in lower grades. Comprehensive sexual health education in lower grades has always been, and remains, optional. Under existing law, for grades 6 and below, an LEA must “opt-in” to offer that instruction to students. The LEA is then required by law to notify parents and guardians of their right to “opt-out” their child, whether in part or completely. All instruction and materials in grades K–6 must meet the instructional criteria or baseline requirements of the CHYA and the content that is required in grades 7–12 may be also be included in an age-appropriate way in earlier grades.
- 2019 Revision of the Health Education Framework. On May 8, 2019, the State Board of Education (SBE) officially adopted the 2019 Health Education Curriculum Framework for California Public Schools (the Health Education Framework) after over two years of development. The Health Education Framework is aligned to the 2008 California Health Education Content Standards, which support the development of knowledge, skills, and attitudes in eight overarching standards: (a) essential health concepts; (b) analyzing health influences; (c) accessing valid health information; (d) interpersonal communication; (5) decision making; (e) goal setting; (f) practicing health-enhancing behaviors; and (g) health promotion in six content areas of health education, including sexual health.
- Inequities persist. The STI crisis affects communities across the state, but California youth, people of color, and gay, bisexual, and transgender people are disproportionately impacted. Statewide data indicate over half of all STIs in the state are experienced among California youth ages 15 to 24 years old. African Americans are 500% more likely to contract gonorrhea and chlamydia than their white counterparts. CDC studies suggest a range of factors may contribute to rising STD rates, including inequitable access to health care and culturally competent medical services, race, poverty, stigma, discrimination, and drug use.
- Costs of STIs. The CDC estimates that STI infections acquired in 2018 totaled nearly $16 billion in direct lifetime medical costs nationwide. Chlamydia, gonorrhea, and syphilis accounted for more than $1 billion of the total cost. Sexually acquired HIV and HPV were the costliest due to lifetime treatment for HIV at $13.7 billion and treatment for HPV-related cancers at $755 million. Approximately $1 billion is spent annually in California on health costs associated with STIs.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes
According to the Senate Appropriations Committee, by requiring schools to provide condoms for free to students in grades 9 through 12, this bill could result in a reimbursable state mandate. The magnitude of the costs is unknown but could be in the high hundreds of thousands to low millions of dollars in Proposition 98 General Fund each year. To the extent that school districts elect not to file mandate claims for these activities, this could place additional cost pressure on the K-12 Mandate Block Grant.
This bill’s requirement to provide coverage for immunization again HPV could result in increased program costs potentially in the low tens of millions of dollars each year. A precise amount will largely depend on the actual take up rate of eligible Medi-Cal recipients.
The Department of Public Health indicates that any costs to the department related to this bill’s prohibition on retail establishments would be minor and absorbable within existing resources.
SUPPORT: (Verified 5/19/23)
Adolescent Health Working Group (co-source)
Black Women for Wellness Action Project (co-source)
Citizens for Choice (co-source)
Essential Access Health (co-source)
ACLU California Action
Aids Healthcare Foundation
American College of Obstetricians and Gynecologists District IX
California Coalition for Youth
California Federation of Teachers
California Nurse Midwives Association
California School-Based Health Alliance
California Teachers Association
California Women's Law Center
CAPSLO the Center for Health & Prevention
Coachman Moore and Associates
Dpa
Genders & Sexualities Alliance Network
GENup
NARAL Pro-Choice California
National Center for Youth Law
National Harm Reduction Coalition
Planned Parenthood Affiliates of California
Radiant Health Centers
Realistic Education in Action Coalition to Foster Health
San Francisco Aids Foundation
The L.A. Trust for Children's Health
Training in Early Abortion for Comprehensive Health Care
URGE Califoria
Women's Foundation of California, Dr. Beatriz Maria Solis Policy Institute
OPPOSITION: (Verified 5/19/23)
15 individuals
ARGUMENTS IN SUPPORT: According to Black Women for Wellness Action Project, Essential Access Health, GenUP, and URGE California “ In a survey conducted among teens on Instagram in 2021, 55% of respondents agreed that more sexually active teens would use condoms if they were easier to obtain, and 60% agreed that schools should make condoms available. Some schools in the state already distribute free condoms on campus, including schools in the Los Angeles and San Francisco Unified School Districts, leaving youth in other regions – including regions with some of the highest rates of STIs and pregnancies among youth – without equitable access to condoms and preventive health care. In 2020, Vermont became the first state in the country to require middle and high schools to make free condoms readily available to students. In 2021, the Chicago Public Schools Board of Education passed a new policy requiring all schools serving 5th grade and above to dispense condoms provided by the Chicago Department of Public Health. California youth need and deserve equitable access to condoms to protect their health and safety. To support youth health and wellness, and curb STI transmission, SB 541 will expand access to condoms by requiring public schools to provide free condoms to students in grades 7 through 12 in alignment with requirements outlined in the California Healthy Youth Act. In addition, SB 541 seeks to prohibit pharmacies and retailers from asking for proof of age for condom purchases, and require the Family PACT program to cover the HPV vaccine for minors so they can access this potentially life-saving intervention from providers they know and trust to deliver confidential sexual and reproductive health services.”
Prepared by: Kordell Hampton / ED. / (916) 651-4105
5/23/23 13:28:22
**** END ****
SENATE COMMITTEE ON APPROPRIATIONS
Senator Anthony Portantino, Chair
2023 - 2024 Regular Session
SB 541 (Menjivar) - Sexual health: contraceptives: immunization
Version: March 30, 2023 | Policy Vote: ED. 5 - 2, HEALTH 10 - 1 |
Urgency: No | Mandate: Yes |
Hearing Date: May 18, 2023 | Consultant: Lenin Del Castillo |
Bill Summary:
This bill requires schools, on or before the start of the 2024-25 school year, to make internal and external condoms available for free to all students in grades 9 through 12. This bill also requires the existing Family Planning Access Care Treatment (PACT) program to provide coverage for immunization against human papilloma virus (HPV) to persons 18 years of age or younger.
*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on May 18, 2023
Fiscal Impact:
- By requiring schools to provide condoms for free to students in grades 9 through 12, this bill could result in a reimbursable state mandate. The magnitude of the costs is unknown but could be in the high hundreds of thousands to low millions of dollars in Proposition 98 General Fund each year. To the extent that school districts elect not to file mandate claims for these activities, this could place additional cost pressure on the K-12 Mandate Block Grant.
- The bill’s requirement to provide coverage for immunization again HPV could result in increased program costs potentially in the low tens of millions of dollars each year. A precise amount will largely depend on the actual take up rate of eligible Medi-Cal recipients.
- The Department of Public Health indicates that any costs to the department related to the bill’s prohibition on retail establishments would be minor and absorbable within existing resources.
Author Amendments:
Encourage schools to explore partnerships with local health jurisdictions, community health centers, nonprofit organizations, and the State Department of Public Health to comply with the bill’s requirement to make condoms available; provide that the Family PACT will cover the HPV vaccine for minors 12 to 18 at Family PACT provider sites, as specified; make clarifying changes; and add coauthors.
-- END --
SENATE COMMITTEE ON APPROPRIATIONS
Senator Anthony Portantino, Chair
2023 - 2024 Regular Session
SB 541 (Menjivar) - Sexual health: contraceptives: immunization
Version: March 30, 2023 | Policy Vote: ED. 5 - 2, HEALTH 10 - 1 |
Urgency: No | Mandate: Yes |
Hearing Date: April 24, 2023 | Consultant: Lenin Del Castillo |
Bill Summary:
This bill requires schools, on or before the start of the 2024-25 school year, to make internal and external condoms available for free to all students in grades 9 through 12. This bill also requires the existing Family Planning Access Care Treatment (PACT) program to provide coverage for immunization against human papilloma virus (HPV) to persons 18 years of age or younger.
Fiscal Impact:
- By requiring schools to provide condoms for free to students in grades 9 through 12, this bill could result in a reimbursable state mandate. The magnitude of the costs is unknown but could be in the high hundreds of thousands to low millions of dollars in Proposition 98 General Fund each year. To the extent that school districts elect not to file mandate claims for these activities, this could place additional cost pressure on the K-12 Mandates Block Grant.
- The bill’s requirement to provide coverage for immunization again HPV could result in increased program costs potentially in the low tens of millions of dollars each year. A precise amount will largely depend on the actual take up rate of eligible Medi-Cal recipients.
- The Department of Public Health indicates that any costs to the department related to the bill’s prohibition on retail establishments would be minor and absorbable within existing resources.
Background:
Existing law establishes the California Healthy Youth Act (CHYA), which requires local educational agencies (LEAs) to provide comprehensive sexual health and HIV prevention instruction to all students in grades 7 to 12, at least once in middle school and once in high school. LEAs are authorized to contract with outside consultants or guest speakers, including those who have developed multilingual curricula or curricula accessible to persons with disabilities, to deliver comprehensive sexual health education and HIV prevention education or to provide training for school district personnel. All outside consultants and guest speakers shall have expertise in comprehensive sexual health education and HIV prevention education and have knowledge of the most recent medically accurate research on the relevant topic or topics covered in their instruction.
Existing law requires that pupils in grades 7 to 12, inclusive, receive comprehensive sexual health education at least once in junior high or middle school and at least once in high school, as specified. LEAs are authorized to provide comprehensive sexual health education and HIV prevention education earlier than grade 7 using instructors trained in the appropriate courses and age-appropriate and medically-accurate information.
The Family PACT Program is administered by the Department of Health Care Services (DHCS) Office of Family Planning and has been operating since 1997 to provide family planning and reproductive health services at no cost to California’s low-income (under 200% federal poverty level) residents of reproductive age. The program offers comprehensive family planning services, including contraception, pregnancy testing, and sterilization, as well as sexually transmitted infection testing and limited cancer screening services. The program serves 1.1 million income-eligible men and women of childbearing age through a network of 2,400 public and private providers.
Proposed Law:
This bill requires, on or before the start of the 2024–25 school year, each public school to make condoms available to all pupils free of charge. The bill specifies that each public school shall distribute condoms in the following manner:
- Condoms shall be placed in a minimum of two locations on school grounds where the condoms are easily accessible to pupils during school hours without requiring assistance or permission from school staff.
- Condoms placed in unsupervised locations shall be stored in tamper-proof dispensers.
This bill requires, commencing the 2024-25 school year, each public school to post at least one notice regarding the bill’s requirements and shall prominently and conspicuously display the notice on the school campus in appropriate areas that are accessible to, and commonly frequented by students, as specified.
This bill permits groups identified by the California Healthy Youth Act, school-sanctioned pupil peer health programs and fairs, and school-based health center staff, to distribute condoms to public schools serving grades 7 to 12, inclusive, during the course of, or in connection to, educational or public health programs and initiatives.
This bill permits a state agency, CDE, or a public school may accept gifts, grants, and donations from any source for the support of a public school carrying out the provisions of this bill, including, but not limited to, the acceptance of condoms from a manufacturer or wholesaler.
This bill prohibits a retail establishment from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age, as specified.
This bill requires the Family PACT Program to provide medical coverage for immunization against HPV to persons who are 18 years of age or younger, and clarifies that this does not prohibit DHCS from providing that coverage to persons who are over 18 years of age through the Family PACT Program.
Related Legislation:
AB 367 (C.Garcia, Chapter 664, Statutes of 2021) requires all public schools serving students in grades 6 to 12 to stock specified restrooms with an adequate supply of free menstrual products, commencing in the 2022-23 school year; and requires the CSU and each community college district, and encourages the UC, independent institutions of higher education, and private postsecondary educational institutions, to stock an adequate supply of free menstrual products at no fewer than one designated and accessible central location on each campus.
AB 10 (C. Garcia, Chapter 687, Statutes of 2017) requires a public school serving grades 6 to grade 12 that meets the 40% pupil poverty threshold required to operate a schoolwide Title 1 program to stock at least 50 percent of the school’s restrooms with feminine hygiene products at all times.
Staff Comments: By requiring schools to provide condoms for free to students in grades 9 to 12, the Commission on State Mandates is likely to determine the requirement to be a higher level of service and therefore a reimbursable state mandate. The associated costs could be significant, potentially in the high hundreds of thousands to low millions to low millions of dollars each year. Alternatively, there could be pressure for the state to provide an increase to the K-12 Mandates Block grant. The amount of funding provided through the block grant is tied to the mandates that the Commission has approved as well as the costs for those mandates. School districts that choose to participate in the block grant receive a per-student amount to cover the cost of the various state mandated activities in lieu of submitting mandate claims for reimbursement. Charter schools may participate in the block grant, but are not eligible to submit mandate claims nor receive reimbursement from the state. The 2022 Budget Act includes $242.3 million for the K-12 Mandates Block Grant.
-- END --
SENATE COMMITTEE ON HEALTH
Senator Dr. Susan Talamantes Eggman, Chair
BILL NO: SB 541
AUTHOR: | Menjivar | ||
VERSION: | March 30, 2023 | ||
HEARING DATE: | April 12, 2023 | ||
CONSULTANT: | Melanie Moreno | ||
SUBJECT: Sexual health: contraceptives: immunization
SUMMARY:
Requires the Family PACT program to provide coverage for immunization against human papilloma virus to persons 18 years of age or younger.
Existing law: Establishes the Department of Health Care Services (DHCS) to administer the Family PACT program, which provides comprehensive clinical family planning services to low income persons. [WIC §14132, et seq.]
This bill:
- Requires the Family PACT program to provide coverage for immunization against human papilloma virus (HPV), as clinically indicated, to persons 18 years of age or younger.
- Prohibits a retail establishment from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age.
Education Code provisions
- Requires public schools, on or before the start of the 2024–25 school year, to make internal and external condoms available free of charge to all pupils in grades 9 to 12, as specified.
- Requires public schools to inform pupils through existing communication channels that free condoms are available, and where the condoms can be obtained on school grounds, as specified. Requires schools to post at least one notice that includes, among other things, contact information for a designated individual responsible for maintaining the supply of condoms; information about abstinence from sexual activity and injection drug use being the only certain way to prevent HIV and other sexually transmitted infections (STIs), and that abstinence from sexual intercourse is the only certain way to prevent unintended pregnancy; information about how to use condoms properly; and, information on how to access local resources and pupils’ legal rights to access those resources for sexual and reproductive health care, as well as local resources for assistance with sexual assault and intimate partner violence.
- Requires public schools serving 7 to 12 grades to allow the distribution of condoms during the course of, or in connection with, educational or public health programs and initiatives, including, but not limited to, community organizations or other entities providing instruction for purposes of the California Healthy Youth; pupil peer health programs, clubs, or groups; pupil health fairs conducted on campus; or, school-based health center staff. Prohibits public schools serving any grades 7 to 12 from prohibiting a school-based health center from making condoms available and easily accessible to pupils.
- Permits state agencies or public schools to accept gifts, grants, and donations from any source for the support of a public school carrying out the provisions of this bill, as specified.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
COMMENTS:
- Author’s statement. According to the author, the COVID-19 public health emergency exacerbated STI rates in California and across the country that were already skyrocketing to crisis levels prior to the pandemic. Nearly 350,000 Californians were infected with syphilis, chlamydia, or gonorrhea in 2019. California youth – teens and young adults of color in particular – are disproportionately impacted. Statewide data indicate over half of all STIs in the state are experienced among young people ages 15 to 24 years old. This bill seeks to address the STI epidemic among California youth and improve equitable public health outcomes statewide by expanding teen access to condoms and the HPV vaccine.
- Background. The Centers for Disease Control and Prevention (CDC) estimates that one in five people in the U.S. have an STI. In 2018, nearly 68 million STI infections were reported nationwide, and rates of syphilis, chlamydia, or gonorrhea are up 40% since 2013. According to CDPH, based on 2020 CDC data, California had the highest number of reported chlamydia, gonorrhea, and adult syphilis cases, as well as the second most congenital syphilis cases of all states. STIs are often asymptomatic (especially in women) and are therefore often undiagnosed and unreported. Untreated STIs can have severe health consequences, including chronic pelvic pain, infertility, miscarriage or newborn death, and increased risk of HIV infection, genital and oral cancers, neurological and rheumatological effects. The CDC estimates that untreated STIs cause at least 24,000 women in the U.S. each year to become infertile. Untreated syphilis can also lead to negative maternal child health outcomes, including infant deaths. The CDC estimates that of pregnant women who acquire syphilis up to four years before delivery, 80% will transmit the infection to the fetus, and 40% may result in stillbirth or death.
- Inequities persist. The STI crisis affects communities across the state, but California youth, people of color, and gay, bisexual, and transgender people are disproportionately impacted. Statewide data indicate over half of all STIs in the state are experienced among California youth ages 15 to 24 years old. African Americans are 500% more likely to contract gonorrhea and chlamydia than their white counterparts. CDC studies suggest a range of factors may contribute to rising STD rates, including inequitable access to health care and culturally competent medical services, race, poverty, stigma, discrimination, and drug use.
- Costs of STIs. The CDC estimates that STI infections acquired in 2018 totaled nearly $16 billion in direct lifetime medical costs nationwide. Chlamydia, gonorrhea, and syphilis accounted for more than $1 billion of the total cost. Sexually acquired HIV and HPV were the costliest due to lifetime treatment for HIV at $13.7 billion and treatment for HPV-related cancers at $755 million. Approximately $1 billion is spent annually in California on health costs associated with STIs.
- Double referral. This bill was heard in the Senate Education Committee on March 29, 2023, and passed with a 5-2 vote.
- Related legislation. AB 659 (Aguiar-Curry) requires Family PACT, health plans, and insurers to provide coverage for the HPV vaccine; states that it is the public policy of the state that pupils are expected to be fully immunized against HPV before admission or advancement to the 8th grade at any private or public elementary or secondary school, and requires schools to notify parents of this policy; requires the California State University, the University of California, and the California Community Colleges to require the first-time enrollees who are 26 years of age or younger to provide proof of full immunization against HPV prior to enrollment. AB 659 is pending in the Assembly Health Committee.
- Prior legislation. AB 2312 (Lee) would have prohibited retail establishments from refusing to furnish nonprescription contraception solely on the basis of age, sex, race, color, religion, ancestry, national origin, disability, medical condition, genetic information, marital status, sexual orientation, citizenship, primary language, or immigration status. AB 2312 was not heard in the Assembly Health Committee.
AB 2516 (Aguiar-Curry) would have required Family PACT, health plans, and insurers to provide coverage for the HPV vaccine. AB 2516 was vetoed by the Governor, who stated, in part:
This bill would expand the definition of "comprehensive family planning services" under Family PACT to include the HPV vaccine as a covered benefit for children and adolescents ages 9 to 18 years of age. For this age group, the HPV vaccine is available through Medi-Cal and the [Vaccines for Children] VFC programs. As a result, AB 2516’s proposal to provide the HPV vaccine in the Family PACT program to individuals who are already covered through the VFC program would result in millions of dollars in General Fund expenditures not included in the Budget Act of 2022 and would not be available for federal reimbursement.
The 2022 Budget Act includes $8 million ($4.6 million General Fund) to add the HPV vaccine under the FamilyPACT program for individuals ages 19 through 45. While I support the author’s efforts to address STI prevention, proposals with an ongoing fiscal impact should be considered through the annual budget process.
SB 306 (Pan, Chapter 486, Statutes of 2021) permits pharmacists to dispense a drug, without the name of an individual for whom the drug is intended, when prescribed for the sexual partner of someone who has been diagnosed with a STI; requires a syphilis blood test to be administered during the third trimester of pregnancy and at delivery, as specified; requires public and commercial health coverage of home STI test kits; and, adds rapid STI tests to existing law which permits HIV counselors to perform rapid HIV and hepatitis C tests.
SB 855 (Pan of 2020) would have permitted the Family PACT program to offer covered benefits to income-eligible patients, even if contraception is not discussed during the patient encounter, among other provisions. SB 855 was not heard in the Senate Business, Professions, and Economic Development Committee.
- Support. The sponsors of this bill write that vaccination rates against HPV are down nationwide due to the COVID-19 pandemic, putting teens and young people at risk of developing HPV-related cancers later in life. The CDC estimates that HPV is responsible for more than 90% of anal and cervical cancers, and about 70% of vaginal and vulvar cancers. While nearly 80% of California teens received the first of three doses of the HPV vaccine in 2020, the vast majority do not complete the full vaccination series, leaving them without maximum protection. Many young people rely on the state’s family planning program, Family PACT, to obtain free and confidential family planning and related services including STI counseling, testing and treatment. The program served more than 85,000 teens in 2019 alone. Family PACT began covering the HPV vaccine in 2022 when the expanded benefit was included in the Fiscal Year 2022-2023 State Budget but the policy fell short. Family PACT only extended the HPV vaccine benefit for patients 19 and older, with the rationale that minors can obtain the vaccine from the VFC program. While there are more than 2,000 Family PACT health providers, not all of them are VFC providers and don’t have the ability to provide the HPV vaccine to minors. The policy leaves thousands of teens unable to get a potentially life-saving vaccine while getting other sexual and reproductive health services in a confidential and non-judgmental health care setting, negatively affecting their continuity of care and unnecessarily denying them access to the vaccine.
SUPPORT AND OPPOSITION:
Support: Black Women for Wellness Action Project (sponsor)
Essential Access Health (sponsor)
GenUP (sponsor)
URGE CA (sponsor)
ACT for Women and Girls
Adolescent Health Working Group
AIDS Healthcare Foundation
American College of Obstetricians and Gynecologists District IX
California Coalition for Youth
California School-Based Health Alliance
California Teachers Association
California Women's Law Center
Citizens for Choice
Coachman Moore & Associates
DAP Health
Genders & Sexualities Alliance Network
GLIDE
NARAL Pro-Choice California
National Center for Youth Law
National Harm Reduction Coalition
Planned Parenthood Affiliates of California
Radiant Health Centers
REACH LA
San Francisco AIDS Foundation
TEACH
The Los Angeles Trust for Children's Health
UCLA Bixby Center on Population and Reproductive Health
Women's Foundation California
Women’s Health Specialist’s
Two individuals
Oppose: Two individuals
-- END --
SENATE COMMITTEE ON EDUCATION
Senator Josh Newman, Chair
2023 - 2024 Regular
Bill No: Hearing Date: March 29, 2023
Author: | Menjivar | ||
Version: | March 20, 2023 | ||
Urgency: | Fiscal: | ||
Consultant: | |||
Subject:
NOTE: This bill has been referred to the Committees on Education and Health. A "do pass" motion should include referral to the Committee on Health.
SUMMARY
This bill requires 1) all public schools, on or before the 2024–25 school year, to make internal and external condoms (condoms) available to all pupils free of charge, as specified; 2) prohibits a retail establishment from refusing to furnish nonprescription contraception to a person solely on the basis of age; and 3) requires the Family Planning, Access, Care, and Treatment (Family PACT) program to provide medical coverage for immunization against human papillomavirus (HPV)to persons who are 18 years of age or younger.
BACKGROUND
Existing Law
Education Code (EDC)
- Establishes the California Healthy Youth Act (CHYA), which requires local educational agencies (LEAs) to provide comprehensive sexual health and HIV prevention instruction to all students in grades 7 to 12, at least once in middle school and once in high school. (EDC § 51933)
- Authorizes an LEA to contract with outside consultants or guest speakers, including those who have developed multilingual curricula or curricula accessible to persons with disabilities, to deliver comprehensive sexual health education and HIV prevention education or to provide training for school district personnel. All outside consultants and guest speakers shall have expertise in comprehensive sexual health education and HIV prevention education and have knowledge of the most recent medically accurate research on the relevant topic or topics covered in their instruction. (EDC § 51936)
- Requires that pupils in grades 7 to 12, inclusive, receive comprehensive sexual health education at least once in junior high or middle school and at least once in high school. (EDC § 51934)
4) Requires that the instruction and related instructional materials be, among other things:
a) Age appropriate.
b) Medically accurate and objective.
c) Appropriate for use with pupils of all races, genders, sexual orientations, and ethnic and cultural backgrounds, pupils with disabilities, and English learners.
d) Made available on an equal basis to a pupil who is an English learner, consistent with the existing curriculum and alternative options for an English learner pupil.
e) Accessible to pupils with disabilities. (EDC § 51934)
- Authorizes an LEA to provide comprehensive sexual health education and HIV prevention education earlier than grade 7 using instructors trained in the appropriate courses and age-appropriate and medically-accurate information. (EDC § 51933)
- Requires LEAs to provide parents and guardians with a notice at the beginning of each school year, or, for a pupil who enrolls in a school after the beginning of the school year, at the time of that pupil’s enrollment the following:
a) About instruction in comprehensive sexual health education and HIV prevention education and research on pupil health behaviors and risks planned for the coming year.
b) Advise the parent or guardian that the educational materials used in sexual health education are available for inspection.
c) Advise the parent or guardian whether the comprehensive sexual health education or HIV prevention education will be taught by school district personnel or by outside consultant, as provided.
d) Advise the parent or guardian that the parent or guardian has the right to excuse their child from comprehensive sexual health education and HIV prevention education and that in order to excuse their child they must state their request in writing to the LEA. (EDC § 51938)
- Provides that the parent or guardian of a pupil has the right to excuse their child from all or part of that education, including related assessments, through a passive consent (“opt-out”) process. (EDC § 51938)
ANALYSIS
This bill requires 1) all public schools, on or before the 2024–25 school year, to make condoms available to all pupils free of charge, as specified; 2) prohibits a retail establishment from refusing to furnish nonprescription contraception to a person solely on the basis of age; and 3) requires the Family PACT program to provide medical coverage for immunization against HPV to persons who are 18 years of age or younger. Specifically this bill:
K-12 Schools
- Requires, on or before the start of the 2024–25 school year, each public school to make condoms available to all pupils free of charge.
- Specifies each public school shall distribute condoms in the following manner:
- Condoms shall be placed in a minimum of two locations on school grounds where the condoms are easily accessible to pupils during school hours without requiring assistance or permission from school staff.
- Condoms placed in unsupervised locations shall be stored in tamper-proof dispensers.
- Requires, commencing the 2024-25 school year, each public school to post at least one notice regarding the requirements of this bill in a prominent and conspicuous location on the school campus with the text of this bill and contact information, including an email address and telephone number, for a designated individual responsible for maintaining the requisite supply of condoms.
- Permits groups identified by the California Healthy Youth Act, school-sanctioned pupil peer health programs and fairs, and school-based health center staff, to distribute condoms to public schools serving grades 7 to 12, inclusive, during the course of, or in connection to, educational or public health programs and initiatives.
- States that school-based health center sites located on school campuses maintaining any combination of classrooms from grades 7 to 12, inclusive, may not be prohibited from making internal and external condoms available and easily accessible at the school-based health center site to all pupils free of charge.
- Defines “public school” as a school operated by a school district, a school operated by a county office of education, and a charter school.
Retail Establishments
- Prohibits a retail establishment from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age.
- Clarifies that a retail establishment from refusing to furnish nonprescription contraception to a person solely on the basis of age by means of any conduct, including, but not limited to, requiring the customer to present identification for purposes of demonstrating their age does not apply to the refusal to furnish nonprescription contraception on the basis of age if, under other provisions of federal or state law, the contraception is subject to restrictions on the basis of age.
- Defines “retail establishment” means any vendor that, in the regular course of business, furnishes nonprescription contraception at retail directly to the public, including, but not limited to, a pharmacy, grocery store, or other retail store.
Family PACT Program
- Requires the Family PACT to provide medical coverage for immunization against HPV to persons who are 18 years of age or younger, and clarifies that this does not prohibit the Department of Health Care Services (DHCS) from providing that coverage to persons who are over 18 years of age through the Family PACT Program.
Other Provisions
- Makes finding and declarations relative to sexual health.
STAFF COMMENTS
- Need for the bill. According to the author “ By requiring free condoms in all California high schools, we are empowering the youth who decide to become sexually active to protect themselves and their partners from STIs, while also removing barriers that potentially shame them and lead to unsafe sex. Further, requiring the Family PACT program to cover HPV vaccinations for ages 12-18 will decrease instances of patients delaying vaccination or becoming discouraged after being turned away. These programs can instill safe sexual habits among youth, protecting themselves now and into adulthood.”
- California Healthy Youth Act. The CHYA took effect in 2003 and was initially known as the Comprehensive Sexual Health and HIV/AIDS Prevention Education Act. Originally, the act LEAs to provide comprehensive sexual health education in any grade, including kindergarten, so long as it consisted of age-appropriate instruction and used instructors trained in the appropriate courses. Beginning in 2016 with AB 329 (Weber, 2015), the act was renamed the CHYA and, for the first time, required LEAs, excluding charter schools, to provide comprehensive sexual health education and HIV prevention education to all students at least once in middle school and at least once in high school. Charter schools must also provide that same instruction. From its inception in 2003 through today, the CHYA has always afforded parents the right to opt their child out of a portion, or all, of the instruction and required LEAs to notify parents and guardians of this right. Parents and guardians can exercise this right by informing the LEA in writing of their decision.
The California Healthy Youth Act requires each school district to ensure that all pupils in grades 7 to 12 receive comprehensive sexual health education and HIV prevention education from instructors trained in the appropriate courses at least once in middle school and high school. The author may wish to consider aligning the grade range, in which each public school must provide condoms to students free of charge, with the California Healthy Youth Act.
- Author Amendment.
- Narrows the scope of the bill to apply to public schools serving students in grades 9-12 in which public school must make condoms available on or before that start of the 2024-25 school year free of charge.
- Committee Amendment. Staff recommends, and the author has agreed, to take the following committee amendments:
- Clarify that a public school must prominently and conspicuously display the notice, regarding condoms, on the school campus in appropriate areas that are accessible to, and commonly frequented by, pupils.
- Permits a state agency, CDE, or a public school may accept gifts, grants, and donations from any source for the support of a public school carrying out the provisions of this bill, including, but not limited to, the acceptance of condoms from a manufacturer or wholesaler.
- Clarify that a public school cannot prohibit a school-based health center from making internal and external condoms available and easily accessible to pupils.
- Makes technical changes.
As proposed to be amended (both author and committee amendments) the K-12 provision of this bill would do the following: Require public schools, serving students in grades 9-12, on or before the 2024-25 school year, to a) make condoms available to students in grades 9-12, free of charge, as specified; b) allow, in certain instances, for condoms to available to students in grades 7-12 free of charge, as specified; and c) prohibits a public school, serving any combination of pupils in grades 7-12, from prohibiting a school-based health center to distribute condoms to students at a school.
- Comprehensive sexual health education in lower grades. Comprehensive sexual health education in lower grades has always been, and remains, optional. Under existing law, for grades 6 and below, an LEA must “opt-in” to offer that instruction to students. The LEA is then required by law to notify parents and guardians of their right to “opt-out” their child, whether in part or completely. All instruction and materials in grades K–6 must meet the instructional criteria or baseline requirements of the CHYA and the content that is required in grades 7–12 may be also be included in an age-appropriate way in earlier grades.
- 2019 Revision of the Health Education Framework. On May 8, 2019, the State Board of Education (SBE) officially adopted the 2019 Health Education Curriculum Framework for California Public Schools (the Health Education Framework) after over two years of development. The Health Education Framework is aligned to the 2008 California Health Education Content Standards, which support the development of knowledge, skills, and attitudes in eight overarching standards: (1) essential health concepts; (2) analyzing health influences; (3) accessing valid health information; (4) interpersonal communication; (5) decision making; (6) goal setting; (7) practicing health-enhancing behaviors; and (8) health promotion in six content areas of health education, including sexual health.
- Family PACT Program. The Family PACT Program is administered by the DHCS, the Office of Family Planning and has been operating since 1997 to provide family planning and reproductive health services at no cost to California’s low-income (under 200% federal poverty level) residents of reproductive age. The program offers comprehensive family planning services, including contraception, pregnancy testing, and sterilization, as well as sexually transmitted infection testing and limited cancer screening services. Family PACT serves 1.1 million income-eligible men and women of childbearing age through a network of 2,400 public and private providers.
- Related Legislation.
AB 329 (Weber), Chapter 398, Statutes 2016, made instruction in sexual health education mandatory, revises human immunodeficiency virus (HIV) prevention education content, expands topics covered in sexual health education, requires this instruction to be inclusive of different sexual orientations, and clarifies parental consent policy.
AB 367 (C.Garcia), Chapter 664, Statutes of 2021, requires all public schools serving students in grades 6 to 12 to stock specified restrooms with an adequate supply of free menstrual products, commencing in the 2022-23 school year; and requires the California State University (CSU) and each community college district, and encourages the Regents of the University of California (UC), independent institutions of higher education, and private postsecondary educational institutions, to stock an adequate supply of free menstrual products at no fewer than one designated and accessible central location on each campus.
AB 10 (C. Garcia,) Chapter 687, Statutes of 2017, requires a public school serving grades 6 to grade 12 that meets the 40% pupil poverty threshold required to operate a schoolwide Title 1 program to stock at least 50% of the school’s restrooms with feminine hygiene products at all times.
SB 1165 (Mitchell), Chapter 713, Statutes of 2014, requires the Instructional Quality Commission to consider including in the next revision of the health framework, instruction on sexual abuse and sex trafficking prevention.
AB 2016 (Campos), Chapter 809, Statutes of 2014, requires the State Board of Education to consider including age-appropriate content on sexual abuse and sexual assault awareness and prevention in the next revision of the health content standards.
SUPPORT
Black Women for Wellness Action Project (Co-Sponsor)
Citizens for Choice (Co-Sponsor)
Essential Access Health (Co-Sponsor)
Generation Up (Co-Sponsor)
Urge (Co-Sponsor)
Adolescent Health Working Group
Aids Healthcare Foundation
American College of Obstetricians and Gynecologists District Ix
California Coalition for Youth
California School-based Health Alliance
DPA Health
Genders & Sexualities Alliance Network
Naral Pro-choice California
National Center for Youth Law
National Harm Reduction Coalition
Planned Parenthood Affiliates of California
Radiant Health Centers
Realistic Education in Action Coalition to Foster Health (Reach LA)
San Francisco Aids Foundation
The Los Angeles Trust for Children's Health
Women's Foundation of California
OPPOSITION
13 individuals
-- END --
Discussed in Hearing
2MIN
Senate Floor
2MIN
Assembly Floor
16MIN
Assembly Standing Committee on Health
14MIN
Assembly Standing Committee on Education
4MIN
Senate Floor
15MIN
Senate Standing Committee on Health
17MIN
Senate Standing Committee on Education
Bill Author
