Amended  IN  Assembly  March 23, 2026

CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION

Assembly Bill
No. 2247

Introduced by Assembly Member Elhawary

February 19, 2026

An act to amend Section 13955 of the Government Code, Section 1367.03 of the Health and Safety Code, to amend Section 10133.54 of the Insurance Code, and to add Chapter 9 (commencing Section 8270) to Division 8 of the Welfare and Institutions Code, relating to victim compensation. victims of crime.


LEGISLATIVE COUNSEL'S DIGEST


AB 2247, as amended, Elhawary. Victim compensation. Trauma Healing and Resilience Investment for Victimized and Exposed Youth Act.
Existing law generally provides for the compensation of victims and derivative victims of specified types of crimes by the California Victim Compensation Board from the Restitution Fund, a continuously appropriated fund, for specified losses suffered as a result of those crimes. Existing law sets forth eligibility requirements and limits on the amount of compensation that the board may award, and requires the application for compensation to be verified under penalty of perjury.

This bill would make a technical, nonsubstantive amendment to these provisions.

This bill would create the Trauma Healing and Resilience Investment for Victimized and Exposed Youth Act (T.H.R.I.V.E.) to be administered by the State Department of Health Care Services for the administration of grants to a county or city and county to establish and administer a program to pay for mental health and counseling services for youth survivors of gun violence, as defined, who request those services and who reside in the county or city and county. The bill would require each county or city and county to use funds awarded under these provisions to establish and administer a program to pay for mental health and counseling services for youth survivors of gun violence that live within the county and who request those services, as specified. The bill would require policies and procedures for distributing funds to meet certain requirements, including, among other things, allowing youth survivors of gun violence, or their parents or guardians for survivors who are minors, to attest to their experiences of gun violence without requiring external documentation of the gun violence incident. The bill would prohibit a youth survivor of gun violence from being denied assistance solely on the basis of having another source of funding for mental health care services if that source is not able to fully cover services from the provider or peer support specialist of the youth survivor’s choosing at a rate that is reasonable for the type of service, licensure, and geographic area in which the youth survivor of gun violence resides, as specified. The bill would require the department to annually issue a public report posted on the department’s internet website regarding the impact of the T.H.R.I.V.E..
The bill would create the Trauma Healing and Resilience Investment for Victimized and Exposed Youth Fund to be used by the department for the purposes of this program, upon appropriation by the Legislature. The bill would make client information and records of mental health services provided to these provisions confidential.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer that provides or arranges for the provision of hospital or physician services to comply with specified timely access to care requirements, including ensuring that its network has adequate capacity and availability of licensed health care providers to offer enrollees and insureds appointments that meet specified timeframes.
This bill would require a health care service plan or an insurer, on or after January 1, 2027, to ensure that for an enrollee or an insured requesting a nonurgent appointment with a nonphysician mental health care or substance use disorder provider to be offered an appointment within 5 business days of the request for an appointment for an enrollee or an insured who is a youth survivor of gun violence. The bill would, beginning January 1, 2027, additionally define “urgent care” under these provisions to include a request to initiate services for a survivor of gun violence. By expanding the scope of a crime, this bill would impose a state-mandated local program.
Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NOYES  

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


SECTION 1.

 Section 1367.03 of the Health and Safety Code is amended to read:

1367.03.
 (a) A health care service plan that provides or arranges for the provision of hospital or physician services, including a specialized mental health plan that provides physician or hospital services, or that provides mental health services pursuant to a contract with a full service plan, shall comply with the following timely access requirements:
(1) A health care service plan shall provide or arrange for the provision of covered health care services in a timely manner appropriate for the nature of the enrollee’s condition consistent with good professional practice. A plan shall establish and maintain networks, policies, procedures, and quality assurance monitoring systems and processes sufficient to ensure compliance with this clinical appropriateness standard. A health care service plan that uses a tiered network shall demonstrate compliance with the standards established by this section based on providers available at the lowest cost-sharing tier.
(2) A health care service plan shall ensure that all plan and provider processes necessary to obtain covered health care services, including, but not limited to, prior authorization processes, are completed in a manner that assures the provision of covered health care services to an enrollee in a timely manner appropriate for the enrollee’s condition and in compliance with this section.
(3) If it is necessary for a provider or an enrollee to reschedule an appointment, the appointment shall be promptly rescheduled in a manner that is appropriate for the enrollee’s health care needs, and ensures continuity of care consistent with good professional practice, and consistent with this section and the regulations adopted thereunder.
(4) Interpreter services required by Section 1367.04 of this code and Section 1300.67.04 of Title 28 of the California Code of Regulations shall be coordinated with scheduled appointments for health care services in a manner that ensures the provision of interpreter services at the time of the appointment without imposing delay on the scheduling of the appointment. This subdivision does not modify the requirements established in Section 1300.67.04 of Title 28 of the California Code of Regulations, or approved by the department pursuant to Section 1300.67.04 of Title 28 of the California Code of Regulations for a plan’s language assistance program.
(5) In addition to ensuring compliance with the clinical appropriateness standard set forth in paragraph (1), a health care service plan shall ensure that its network has adequate capacity and availability of licensed health care providers to offer enrollees appointments that meet the following timeframes:
(A) Urgent care appointments for services that do not require prior authorization: within 48 hours of the request for appointment, except as provided in subparagraph (H).
(B) Urgent care appointments for services that require prior authorization: within 96 hours of the request for appointment, except as provided in subparagraph (H).
(C) Nonurgent appointments for primary care: within 10 business days of the request for appointment, except as provided in subparagraphs (H) and (I).
(D) Nonurgent appointments with specialist physicians: within 15 business days of the request for appointment, except as provided in subparagraphs (H) and (I).
(E) Nonurgent appointments with a nonphysician mental health care or substance use disorder provider: within 10 business days of the request for appointment, except as provided in subparagraphs (H) and (I).
(F) Commencing July 1, 2022, nonurgent (i) Nonurgent followup appointments with a nonphysician mental health care or substance use disorder provider: within 10 business days of the prior appointment for those undergoing a course of treatment for an ongoing mental health or substance use disorder condition, or within 5 business days if the enrollee is a youth survivor of gun violence as defined in Section 8271 of the Welfare and Institutions Code, except as provided in subparagraph (H). This subparagraph does not limit coverage for nonurgent followup appointments with a nonphysician mental health care or substance use disorder provider to once every 10 business days.
(ii) The changes made by the act that added this clause shall apply to a health care service plan contract entered into, amended, or renewed on or after January 1, 2027.
(G) Nonurgent appointments for ancillary services for the diagnosis or treatment of injury, illness, or other health condition: within 15 business days of the request for appointment, except as provided in subparagraphs (H) and (I).
(H) The applicable waiting time for a particular appointment may be extended if the referring or treating licensed health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of their practice and consistent with professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the enrollee.
(I) Preventive care services, as defined in subdivision (e), and periodic followup care, including standing referrals to specialists for chronic conditions, periodic office visits to monitor and treat pregnancy, cardiac, mental health, or substance use disorder conditions, and laboratory and radiological monitoring for recurrence of disease, may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed health care provider acting within the scope of their practice.
(J) A referral to a specialist by a primary care provider or another specialist shall be subject to the relevant time-elapsed standard in subparagraph (A), (B), or (D), unless the requirements in subparagraph (H) or (I) are met, and shall be subject to the other provisions of this section.
(K) A plan may demonstrate compliance with the primary care time-elapsed standards established by this subdivision through implementation of standards, processes, and systems providing advanced access to primary care appointments, as defined in subdivision (e).
(6) In addition to ensuring compliance with the clinical appropriateness standard set forth in paragraph (1), each dental plan, and each full service plan offering coverage for dental services, shall ensure that dental networks have adequate capacity and availability of licensed health care providers to offer enrollees appointments for covered dental services in accordance with the following requirements:
(A) Urgent appointments within the dental plan network shall be offered within 72 hours of the time of request for appointment, if consistent with the enrollee’s individual needs and as required by professionally recognized standards of dental practice.
(B) Nonurgent appointments shall be offered within 36 business days of the request for appointment, except as provided in subparagraph (C).
(C) Preventive dental care appointments shall be offered within 40 business days of the request for appointment.
(7) A plan shall ensure it has sufficient numbers of network providers to maintain compliance with the standards established by this section.
(A) This section does not modify the requirements regarding provider-to-enrollee ratio or geographic accessibility established by Section 1300.51, 1300.67.2, or 1300.67.2.1 of Title 28 of the California Code of Regulations.
(B) A plan operating in a network service area that has a shortage of one or more types of providers shall ensure timely access to covered health care services as required by this section, including applicable time-elapsed standards, by referring an enrollee to, or, in the case of a preferred provider network, by assisting an enrollee to locate available and accessible network providers in neighboring network service areas consistent with patterns of practice for obtaining health care services in a timely manner appropriate for the enrollee’s health needs.
(C) A plan shall arrange for the provision of covered services from providers outside the plan’s network if unavailable within the network if medically necessary for the enrollee’s condition. A plan shall ensure that enrollee costs for medically necessary referrals to nonnetwork providers shall not exceed applicable in-network copayments, coinsurance, and deductibles. This requirement does not prohibit a plan or its delegated provider group from accommodating an enrollee’s preference to wait for a later appointment from a specific network provider. If medically necessary treatment of a mental health or substance use disorder is not available in network within the geographic and timely access standards set by law or regulation, a health care service plan shall arrange coverage outside the plan’s network in accordance with subdivision (d) of Section 1374.72.
(8) A plan shall provide or arrange for the provision, 24 hours per day, 7 days per week, of triage or screening services by telephone, as defined in subdivision (e).
(A) A plan shall ensure that telephone triage or screening services are provided in a timely manner appropriate for the enrollee’s condition, and that the triage or screening waiting time does not exceed 30 minutes.
(B) A plan may provide or arrange for the provision of telephone triage or screening services through one or more of the following means: plan-operated telephone triage or screening services, telephone medical advice services pursuant to Section 1348.8, the plan’s primary care and mental health care or substance use disorder network, or another method that provides triage or screening services consistent with this section.
(i) A plan that arranges for the provision of telephone triage or screening services through network primary care, mental health care, and substance use disorder providers shall require those providers to maintain a procedure for triaging or screening enrollee telephone calls, which, at a minimum, shall include the employment, during and after business hours, of a telephone answering machine, an answering service, or office staff, that shall inform the caller of both of the following:
(I) Regarding the length of wait for a return call from the provider.
(II) How the caller may obtain urgent or emergency care, including, if applicable, how to contact another provider who has agreed to be on call to triage or screen by phone, or if needed, deliver urgent or emergency care.
(ii) A plan that arranges for the provision of triage or screening services through network primary care, mental health care, and substance use disorder providers who are unable to meet the time-elapsed standards established in subparagraph (A) shall also provide or arrange for the provision of plan-contracted or operated triage or screening services, which shall, at a minimum, be made available to enrollees affected by that portion of the plan’s network.
(iii) An unlicensed staff person handling enrollee calls may ask questions on behalf of a licensed staff person to help ascertain the condition of an insured so that the enrollee may be referred to licensed staff. However, an unlicensed staff person shall not, under any circumstances, use the answers to those questions in an attempt to assess, evaluate, advise, or make a decision regarding the condition of an enrollee or determine when an enrollee needs to be seen by a licensed medical professional.
(9) Dental, vision, chiropractic, and acupuncture plans shall ensure that network providers employ an answering service or a telephone answering machine during nonbusiness hours, which provide instructions regarding how an enrollee may obtain urgent or emergency care, including, if applicable, how to contact another provider who has agreed to be on call to triage or screen by phone, or if needed, deliver urgent or emergency care.
(10) A plan shall ensure that, during normal business hours, the waiting time for an enrollee to speak by telephone with a plan customer service representative knowledgeable and competent regarding the enrollee’s questions and concerns shall not exceed 10 minutes.
(b) With regard to subdivision (a), dental, vision, chiropractic, and acupuncture plans shall comply with paragraphs (1), (3), (4), (7), (9), and (10).
(c) The obligation of a plan to comply with this section shall not be waived if the plan delegates to its provider groups or other contracting entities any services or activities that the plan is required to perform. A plan’s implementation of this section shall be consistent with the Health Care Providers’ Bill of Rights, and a material change in the obligations of a plan’s network providers shall be considered a material change to the provider contract, within the meaning of subdivision (b) and paragraph (2) of subdivision (h) of Section 1375.7.
(d) A health care service plan shall incorporate the standards set forth in subdivision (a) into the health plan’s quality assurance systems and the processes set forth in Sections 1367 and 1370 of this code and Title 28 of the California Code of Regulations, including Sections 1300.67.2, 1300.67.2.2, 1300.68, and 1300.70. A plan shall not prevent, discourage, or discipline a network provider or employee for informing an enrollee or subscriber about the timely access standards.
(e) For purposes of this section:
(1) “Advanced access” means the provision, by a network provider, or by the provider group to which an enrollee is assigned, of appointments with a primary care physician, or other qualified primary care provider such as a nurse practitioner or physician’s assistant, within the same or next business day from the time an appointment is requested, and advance scheduling of appointments at a later date if the enrollee prefers not to accept the appointment offered within the same or the next business day.
(2) “Appointment waiting time” means the time from the initial request for health care services by an enrollee or the enrollee’s treating provider to the earliest date offered for the appointment for services inclusive of time for obtaining authorization from the plan or completing any other condition or requirement of the plan or its network providers.
(3) “Preventive care” means health care provided for prevention and early detection of disease, illness, injury, or another health condition and, in the case of a full service plan includes all of the basic health care services required by Sections 1345, 1367.002, 1367.3, and 1367.35 of this code and subdivision (f) of Section 1300.67 of Title 28 of the California Code of Regulations.
(4) “Provider group” has the meaning set forth in subdivision (g) of Section 1373.65.
(5) “Triage” or “screening” means the assessment of an enrollee’s health concerns and symptoms via communication with a physician, registered nurse, or other qualified health professional acting within their scope of practice and who is trained to screen or triage an enrollee who may need care for the purpose of determining the urgency of the enrollee’s need for care.
(6) “Triage or screening waiting time” means the time waiting to speak by telephone with a physician, registered nurse, or other qualified health professional acting within their scope of practice and who is trained to screen or triage an enrollee who may need care.
(7) “Urgent care” means health either of the following:
(A) Health care for a condition that requires prompt attention, consistent with paragraph (2) of subdivision (h) of Section 1367.01.
(B) Beginning January 1, 2027, any request to initiate services for an enrollee who is a youth survivor of gun violence, as defined in Section 8271 of the Welfare and Institutions Code, with a nonphysician mental health care or substance use disorder provider.
(f) (1) Contracts between health care service plans and health care providers shall ensure compliance with the standards developed under this chapter. These contracts shall require reporting by health care providers to health care service plans and by health care service plans to the department to ensure compliance with the standards.
(2) Health care service plans shall report annually to the department on compliance with the standards in a manner specified by the department. The reported information shall allow consumers to compare the performance of plans and their network providers in complying with the standards, as well as changes in the compliance of plans with these standards.
(3) The department shall develop standardized methodologies for reporting that shall be used by health care service plans to demonstrate compliance with this section and any regulations adopted pursuant to it, including demonstration of the average waiting time for each class of appointment regulated under this section, except the department may develop methodologies to demonstrate compliance with, and the average appointment wait time for, each class of appointments regulated under paragraph (6) of subdivision (a). The methodologies shall be sufficient to determine compliance with the standards developed under this section for different networks of providers if a health care service plan uses a different network for Medi-Cal managed care products than for other products or if a health care service plan uses a different network for individual market products than for small group market products. The development and adoption of these methodologies shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) until December 31, 2025. The department shall consult with stakeholders in developing standardized methodologies under this paragraph.
(4) Notwithstanding paragraph (3), the department may take compliance or disciplinary action, including assessment of administrative penalties, on the basis of noncompliance with any of the provisions of this section, including, but not limited to, timeframes for appointments and followup appointments.
(5) The department may review and adopt standards, in addition to those specified in this article, concerning the availability of primary care physicians, specialty physicians, hospital care, and other health care, so that consumers have timely access to care. In so doing, the department shall consider the nature of physician practices, including individual and group practices, as well as the nature of the plan network. The department shall also consider various circumstances affecting the delivery of care, including urgent care, care provided on the same day, and requests for specific providers. If the department finds that health care service plans and health care providers have difficulty meeting these standards, the department may make recommendations to the Assembly Committee on Health and the Senate Committee on Health pursuant to subdivision (i). The development and adoption of standards under this paragraph shall not be subject to the Administrative Procedure Act until December 31, 2028. The department shall consult with stakeholders in developing the standards and methodologies described in this section.
(g) (1) The director may investigate and, by order, take enforcement action against plans, including, but not limited to, assessing administrative penalties subject to appropriate notice of, and the opportunity for, a hearing in accordance with Section 1397, regarding noncompliance with the requirements of this section. The director shall consider, as an aggravating factor when assessing administrative penalties, if harm to an enrollee, including financial or health impacts to an enrollee or substantial harm as defined in Section 3428 of the Civil Code, has occurred as a result of plan noncompliance. The director has the discretion to determine what harm constitutes harm to an enrollee. The plan may provide to the director, and the director may consider, information regarding the plan’s overall compliance with the requirements of this section. When taking enforcement action against a plan, the director may consider patterns of noncompliance. The administrative penalties shall not be deemed an exclusive remedy available to the director. These penalties shall be paid to the Managed Care Administrative Fines and Penalties Fund and shall be used for the purposes specified in Section 1341.45. The director shall periodically evaluate grievances to determine if any audit, investigative, or enforcement actions should be undertaken by the department.
(2) The director may, after appropriate notice and opportunity for hearing in accordance with Section 1397, by order, assess administrative penalties if the director determines that a health care service plan has knowingly committed, or has performed with a frequency that indicates a general business practice, either of the following:
(A) Repeated failure to act promptly and reasonably to assure timely access to care consistent with this chapter.
(B) Repeated failure to act promptly and reasonably to require network providers to assure timely access that the plan is required to perform under this chapter and that have been delegated by the plan to the network provider when the obligation of the plan to the enrollee or subscriber is reasonably clear.
(C) The administrative penalties available to the director pursuant to this section are not exclusive, and may be sought and employed in any combination with civil, criminal, and other administrative remedies deemed warranted by the director to enforce this chapter.
(3) The administrative penalties shall be paid to the Managed Care Administrative Fines and Penalties Fund and shall be used for the purposes specified in Section 1341.45.
(h) The department shall work with the patient advocate to assure that the quality of care report card incorporates information provided pursuant to subdivision (f) regarding the degree to which health care service plans and health care providers comply with the requirements for timely access to care.
(i) The department shall annually review information regarding compliance with the standards developed under this section and shall make recommendations for changes that further protect enrollees. Commencing no later than December 1, 2015, and annually thereafter, the department shall post its final findings from the review on its internet website.
(j) The department shall post on its internet website any waivers or alternative standards that the department approves under this section on or after January 1, 2015.
(k) This section applies to a licensed health care service plan that provides services to Medi-Cal beneficiaries. Except for appointment wait time standards set forth in paragraph (5) of subdivision (a) of this section and in Section 1300.67.2.2 of Title 28 of the California Code of Regulations, this section does not alter the requirements or standards of the State Department of Health Care Services specified in Section 14197 of the Welfare and Institutions Code.
(l) This section does not prevent the department from developing additional standards to improve timely access to care and network adequacy.

SEC. 2.

 Section 10133.54 of the Insurance Code is amended to read:

10133.54.
 (a) This section applies to policies of health insurance, as defined by subdivision (b) of Section 106. The requirements of this section apply to all health care services covered by a health insurance policy.
(b) Notwithstanding Section 10133.5, a health insurer shall comply with the timely access requirements in this section, but a specialized health insurance policy as defined in subdivision (c) of Section 106, other than a specialized mental health insurance policy, is exempt from the provisions of this section, except as specified in paragraph (6) and subdivision (c).
(1) A health insurer shall provide or arrange for the provision of covered health care services in a timely manner appropriate for the nature of the insured’s condition, consistent with good professional practice. An insurer shall establish and maintain provider networks, policies, procedures, and quality assurance monitoring systems and processes sufficient to ensure compliance with this clinical appropriateness standard. An insurer that uses a tiered network shall demonstrate compliance with the standards established by this section based on providers available at the lowest cost-sharing tier.
(2) A health insurer shall ensure that all insurer and provider processes necessary to obtain covered health care services, including, but not limited to, prior authorization processes, are completed in a manner that assures the provision of covered health care services to an insured in a timely manner appropriate for the insured’s condition and in compliance with this section.
(3) If it is necessary for a provider or an insured to reschedule an appointment, the appointment shall be promptly rescheduled in a manner that is appropriate for the insured’s health care needs, and ensures continuity of care consistent with good professional practice, and consistent with the objectives of Section 10133.5, the regulations adopted pursuant to Section 10133.5, and this section.
(4) Interpreter services required by Section 10133.8 of this code and Article 12.1 (commencing with Section 2538.1) of Title 10 of the California Code of Regulations shall be coordinated with scheduled appointments for health care services in a manner that ensures the provision of interpreter services at the time of the appointment, consistent with Section 2538.6 of Title 10 of the California Code of Regulations, without imposing delay on the scheduling of the appointment. This subdivision does not modify the requirements established in Sections 10133.8 and 10133.9 of this code and Section 2538.6 of Title 10 of the California Code of Regulations, or approved by the department pursuant to Section 2538.6 of Title 10 of the California Code of Regulations for an insurer’s language assistance program.
(5) In addition to ensuring compliance with the clinical appropriateness standard set forth in paragraph (1), a health insurer shall ensure that its contracted provider network has adequate capacity and availability of licensed health care providers to offer insureds appointments that meet the following timeframes:
(A) Urgent care appointments for services that do not require prior authorization: within 48 hours of the request for appointment, except as provided in subparagraph (H).
(B) Urgent care appointments for services that require prior authorization: within 96 hours of the request for appointment, except as provided in subparagraph (H).
(C) Nonurgent appointments for primary care: within 10 business days of the request for appointment, except as provided in subparagraphs (H) and (I).
(D) Nonurgent appointments with specialist physicians: within 15 business days of the request for appointment, except as provided in subparagraphs (H) and (I).
(E) (i) Nonurgent appointments with a nonphysician mental health care or substance use disorder provider: within 10 business days of the request for appointment, or within 5 business days if the insured is a youth survivor of gun violence, as defined in Section 8271 of the Welfare and Institutions Code, except as provided in subparagraphs (H) and (I).
(ii) The changes made by the act that added this clause shall apply to a health insurance policy entered into, amended, or renewed on or after January 1, 2027.
(F) Commencing July 1, 2022, nonurgent followup appointments with a nonphysician mental health care or substance use disorder provider: within 10 business days of the prior appointment for those undergoing a course of treatment for an ongoing mental health or substance use disorder condition, except as provided in subparagraph (H). This subparagraph does not limit coverage for nonurgent followup appointments with a nonphysician mental health care or substance use disorder provider to once every 10 business days.
(G) Nonurgent appointments for ancillary services for the diagnosis or treatment of injury, illness, or other health condition: within 15 business days of the request for appointment, except as provided in subparagraphs (H) and (I).
(H) The applicable waiting time for a particular appointment may be extended if the referring or treating licensed health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of their practice and consistent with professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the insured.
(I) Preventive care services, as defined in subdivision (e), and periodic follow up care, including standing referrals to specialists for chronic conditions, periodic office visits to monitor and treat pregnancy, cardiac, mental health, or substance use disorder conditions, and laboratory and radiological monitoring for recurrence of disease, may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed health care provider acting within the scope of their practice.
(J) A referral to a specialist by a primary care provider or another specialist shall be subject to the relevant time-elapsed standard in subparagraph (A), (B) or (D), unless the requirements in subparagraph (H) or (I) are met, and shall be subject to the other provisions of this section.
(6) (A) The following types of health insurance policies shall be subject to the requirements in subparagraph (B):
(i) A health insurance policy covering the pediatric oral or vision essential health benefit.
(ii) A specialized health insurance policy that provides coverage for the pediatric oral essential health benefit, as defined in paragraph (5) of subdivision (a) of Section 10112.27.
(iii) A specialized health insurance policy that covers dental benefits only, as defined in subdivision (c) of Section 106.
(B) In addition to ensuring compliance with the clinical appropriateness standard set forth in paragraph (1), each health insurance policy specified in subparagraph (A) shall ensure that contracted oral or vision provider networks have adequate capacity and availability of licensed health care providers, including generalist and specialist dentists, ophthalmologists, optometrists, and opticians, to offer insureds appointments for covered oral or vision services in accordance with the following requirements:
(i) Urgent appointments within the plan network shall be offered within 72 hours of the time of request for appointment, if consistent with the insured’s individual needs and as required by professionally recognized standards of dental practice.
(ii) Nonurgent appointments shall be offered within 36 business days of the request for appointment, except as provided in clause (iii).
(iii) Preventive care appointments shall be offered within 40 business days of the request for appointment.
(iv) The applicable waiting time for a particular appointment in this paragraph may be extended if the referring or treating licensed health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of the provider’s practice and consistent with professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the insured.
(7) An insurer shall ensure it has sufficient numbers of contracted providers to maintain compliance with the standards established by this section.
(A) This section does not modify the requirements regarding accessibility established by Article 6 (commencing with Section 2240) of Title 10 of the California Code of Regulations.
(B) An insurer shall ensure timely access to covered health care services as required by this section, including applicable time-elapsed standards, by assisting an insured to locate available and accessible contracted providers in a timely manner appropriate for the insured’s health needs. An insurer shall arrange for the provision of services outside the insurer’s contracted network if unavailable within the network if medically necessary for the insured’s condition. Insured costs for medically necessary referrals to nonnetwork providers shall not exceed applicable in-network copayments, coinsurance, and deductibles.
(8) An insurer shall provide or arrange for the provision, 24 hours per day, 7 days per week, of triage or screening services by telephone, as defined in subdivision (f).
(A) An insurer shall ensure that telephone triage or screening services are provided in a timely manner appropriate for the insured’s condition, and that the triage or screening waiting time does not exceed 30 minutes.
(B) An insurer may provide or arrange for the provision of telephone triage or screening services through one or more of the following means: insurer-operated telephone triage or screening services, telephone medical advice services pursuant to Section 10279, the insurer’s contracted primary care and mental health care or substance use disorder provider network, or other method that provides triage or screening services consistent with this section.
(i) An insurer that arranges for the provision of telephone triage or screening services through contracted primary care and mental health care and substance use disorder providers shall require those providers to maintain a procedure for triaging or screening insured telephone calls, which, at a minimum, shall include the employment, during and after business hours, of a telephone answering machine, an answering service, or office staff, that shall inform the caller of both of the following:
(I) Regarding the length of wait for a return call from the provider.
(II) How the caller may obtain urgent or emergency care, including, if applicable, how to contact another provider who has agreed to be on call to triage or screen by phone, or if needed, deliver urgent or emergency care.
(ii) An insurer that arranges for the provision of triage or screening services through contracted primary care and mental health care and substance use disorder providers who are unable to meet the time-elapsed standards established in subparagraph (A) shall also provide or arrange for the provision of insurer-contracted or operated triage or screening services, which shall, at a minimum, be made available to insureds affected by that portion of the insurer’s network.
(iii) An unlicensed staff person handling insured calls may ask questions on behalf of a licensed staff person to help ascertain the condition of an insured so that the insured may be referred to licensed staff. However, an unlicensed staff person shall not, under any circumstances, use the answers to those questions in an attempt to assess, evaluate, advise, or make a decision regarding the condition of an insured or determine when an insured needs to be seen by a licensed medical professional.
(9) A health insurance policy providing coverage for the pediatric oral and vision essential health benefit, and a specialized health insurance policy that provides coverage for dental care expenses only, shall require that contracted providers employ an answering service or a telephone answering machine during nonbusiness hours, which provides instructions regarding how an insured may obtain urgent or emergency care, including, if applicable, how to contact another provider who has agreed to be on call to triage or screen by phone, or if needed, deliver urgent or emergency care.
(10) An insurer shall ensure that, during normal business hours, the waiting time for an insured to speak by telephone with an insurer customer service representative knowledgeable and competent regarding the insured’s questions and concerns shall not exceed 10 minutes, or that the covered person will receive a scheduled call-back within 30 minutes.
(c) Notwithstanding subdivision (b), a specialized health insurance policy, as defined in subdivision (c) of Section 106, other than a specialized mental health insurance policy, is exempt from this section, except as specified in this subdivision. A specialized health insurance policy that provides coverage for dental care expenses only shall comply with paragraphs (1), (3), (4), (6), (7), (9), and (10) of subdivision (b).
(d) An insurer shall incorporate the standards set forth in the insurer’s quality assurance systems and processes, as set forth in subdivision (b), and the processes as set forth in Title 10 of the California Code of Regulations, including Sections 2240.1, 2240.15, and 2240.16. An insurer shall not prevent, discourage, or discipline a contracting provider or employee for informing an insured or policyholder about the timely access standards.
(e) For purposes of this section:
(1) “Appointment waiting time” means the time from the initial request for health care services by an insured or the insured’s treating provider to the earliest date offered for the appointment for services inclusive of time for obtaining authorization from the insurer or completing any other condition or requirement of the insurer or its contracting providers.
(2) “Preventive care” means health care provided for prevention and early detection of disease, illness, injury, or other health condition and includes, but is not limited to, all of the services required by all of the following laws:
(A) Section 146.130 of Title 45 of the Code of Federal Regulations.
(B) Section 10112.2 (incorporating the requirements of Section 2713 of the federal Public Health Service Act (42 U.S.C. Sec. 300gg-13)).
(C) Clause (ii) of subparagraph (A) of paragraph (2) of subdivision (a) of Section 10112.27.
(3) “Provider group” has the meaning set forth in subdivision (v) of Section 10133.15.
(4) “Triage” or “screening” means the assessment of an insured’s health concerns and symptoms via communication with a physician, registered nurse, or other qualified health professional acting within their scope of practice and who is trained to screen or triage an insured who may need care for the purpose of determining the urgency of the insured’s need for care.
(5) “Triage or screening waiting time” means the time waiting to speak by telephone with a physician, registered nurse, or other qualified health professional acting within their scope of practice and who is trained to screen or triage an insured who may need care.
(6) “Urgent care” means health either of the following:
(A) Health care for a condition which requires prompt attention, consistent with paragraph (2) of subdivision (h) of Section 10123.135.
(B) Beginning after January 1, 2027, any request to initiate services for an insured who is a youth survivor of gun violence, as defined in Section 8271 of the Welfare and Institutions Code, with a nonphysician mental health care or substance use disorder provider.
(f) (1) The department may issue guidance to insurers regarding annual timely access and network reporting methodologies. The development and adoption of these methodologies shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) until December 31, 2025.
(2) Notwithstanding paragraph (1), the department may take compliance or disciplinary action, including imposition of administrative penalties, on the basis of noncompliance with any of the provisions of this section, including, but not limited to, timeframes for appointments and followup appointments.
(3) The department may review and adopt standards, in addition to those specified in this article, concerning the availability of primary care physicians, specialty physicians, hospital care, and other health care, so that consumers have timely access to care. In so doing, the department shall consider the nature of physician practices, including individual and group practices, as well as the nature of the network. The department shall also consider various circumstances affecting the delivery of care, including urgent care, care provided on the same day, and requests for specific providers. If the department finds that insurers and health care providers have difficulty meeting these standards, the department may make recommendations to the Assembly Committee on Health and the Senate Committee on Health. The development and adoption of standards under this paragraph shall not be subject to the Administrative Procedure Act until December 31, 2028. The department shall consult with stakeholders in developing the standards and methodologies described in this section.
(g) Nothing in this section shall be construed to prevent the department from developing additional standards to improve timely access to care and network adequacy.

SEC. 3.

 Chapter 9 (commencing with Section 8270) is added to Division 8 of the Welfare and Institutions Code, to read:
CHAPTER  9. Trauma Healing and Resilience Investment for Victimized and Exposed Youth Act

8270.
 This chapter shall be known, and may be cited, as the Trauma Healing and Resilience Investment for Victimized and Exposed Youth Act or the T.H.R.I.V.E. Act.

8271.
 For the purposes of this chapter, the following definitions shall apply:
(a) “Community-based organization” means a nonprofit organization, or organization fiscally sponsored by a nonprofit, that provides direct services to youth survivors of gun violence and includes, but is not limited to, a trauma recovery center as described in Section 13963.1 of the Government Code.
(b) “Department” means the State Department of Health Care Services.
(c) “Family member” means any of the following:
(1) A person related to another by blood, adoption, or marriage.
(2) A household member or former household member of another.
(3) A person who is not related by blood, adoption, or marriage to another, but who otherwise has a significant emotional relationship with another.
(d) “Fund” means the Trauma Healing and Resilience Investment for Victimized and Exposed Youth Fund established pursuant to Section 8273.
(e) “Grantee” means a county, city and county, or lead agency designated by a county or city and county to administer funds awarded to the county or city and county under this chapter.
(f) “Law enforcement agency” means any police department, sheriff’s department, district attorney, county probation department, transit agency police department, school district police department, highway patrol, the police department of any campus of the University of California, the California State University, or a community college, the Department of the California Highway Patrol, the Department of Justice, the Department of Corrections and Rehabilitation, and federal law enforcement agencies, including, but not limited to, the Department of Homeland Security, the Federal Bureau of Investigation, Bureau of Alcohol, Tobacco, Firearms and Explosives, and the Drug Enforcement Administration.
(g) “Lead agency” means a department of a county or city and county, including, but not limited to, departments of social services, disability services, health services, public health, or behavioral health. “Lead agency” does not include a law enforcement agency.
(h) “Youth survivor of gun violence” means a person 25 years of age or younger who has experienced any of the following:
(1) Been shot by another person with a firearm.
(2) Been shot at by another person with a firearm, whether the shooting resulted in bodily injury.
(3) Has witnessed someone else being shot or shot at with a firearm.
(4) Has a family member or close friend who has sustained serious bodily injury or death from being shot by another person with a firearm, including a person whose parent was killed with a firearm before the person was born.

8272.
 (a) The Trauma Healing and Resilience Investment for Victimized and Exposed Youth Act or the T.H.R.I.V.E. grant program is hereby established and shall be administered by the department.
(b) (1) The department shall award to each county or city and county a grant to establish and administer a program to pay for mental health and counseling services for youth survivors of gun violence who request those services and who reside in the county or city and county.
(2) The department shall award a first round of grants to each city or city and county within nine months of funds being appropriated for the purpose of implementing this chapter or within nine months of the enactment of this chapter, whichever is later. The department shall award grants each fiscal year thereafter for which funds are available, on a timeline determined by the department.
(3) Any portion of a grant that a grantee does not use in the grant period shall revert to the fund established pursuant to Section 8273.
(c) (1) Each county or city and county shall use funds awarded under this chapter to establish and administer a program to pay for mental health and counseling services for youth survivors of gun violence within the county who request those services.
(2) A county or city and county may designate a lead agency for the purposes of administering a program under this chapter. A county or city and county shall not designate any law enforcement agency as a lead agency.
(d) (1) From funds awarded under this chapter, grantees may provide stipends to youth survivors of gun violence directly, or to their parents or guardians for survivors who are minors, to use to pay for their own mental health and counseling services, may pay providers or peer support specialists directly for mental health and counseling services on behalf of youth survivors, or may provide funds to one or more community-based organizations, to distribute in stipends to youth survivors of gun violence to pay for mental health and counseling services, or to pay providers directly to provide these services.
(2) No more than 10 percent of the funds awarded under this chapter shall be used to support program administration of the grantee or of a community-based organization that receives funds from a grantee to distribute as provided by this section.
(e) Grantees shall establish policies and procedures for distributing funds to youth survivors of gun violence to use to pay for mental health and counseling services that comply with all of the following:
(1) Allow youth survivors of gun violence, or their parents or guardians for survivors who are minors, to attest to their experiences of gun violence without requiring external documentation of the gun violence incident.
(2) Allow youth survivors of gun violence, or their parents or guardians for survivors who are minors, to select a licensed mental health services provider or peer support specialist of their choice, regardless of whether the provider or specialist accepts insurance, Medi-Cal, or another form of coverage.
(3) Provide youth survivors of gun violence with a list of mental health care providers and peer support specialists in the county with expertise in recovery from trauma or violence. This list may include, but is not limited to, providers trained under the Adverse Childhood Experiences (ACEs) Aware Initiative or that are listed in the statewide ACEs Aware Clinician Directory, and who provide individual counseling.
(4) Do not exclude youth survivors of gun violence on the basis of citizenship or immigration status.
(5) Establish a mechanism to ensure youth survivors of gun violence are not required to incur out-of-pocket mental health and counseling expenses or wait to be reimbursed for those costs.
(6) Do not exclude youth survivors of gun violence on the basis of an arrest, conviction, or juvenile adjudication record, or on the basis of a survivor’s status under correctional supervision.
(f) Grantees shall not require, as a condition of receiving mental health and counseling services, that a youth survivor of gun violence report any crime to a law enforcement agency, or require documentation from law enforcement of the incident of gun violence.
(g) A youth survivor of gun violence who has health insurance, Medi-Cal, or is eligible for another government or private program that may provide mental health and counseling services or funds for such services remains eligible to receive funds from a grantee to pay for mental health and counseling services from a licensed mental health services provider or peer support specialist of their choosing who is out of network or not fully covered by another program, at a rate that is reasonable for the type of service, licensure, and geographic area in which the youth survivor of gun violence resides and in an amount not to exceed seven thousand eight hundred dollars ($7,800) annually. A youth survivor of gun violence shall not be denied assistance from a grantee solely on the basis of having another source of funding for mental health care services generally if that source is not able to fully cover services from the provider or peer support specialist of the youth survivor’s choosing at a rate that is reasonable for the type of service, licensure, and geographic area in which the youth survivor of gun violence resides, in an amount not to exceed seven thousand eight hundred dollars ($7,800) annually.
(h) Notwithstanding any other law, a stipend or payment made under this chapter shall not reduce a youth survivor of gun violence’s maximum benefit allowance provided by the California Victim Compensation Board, except that an expense for specific purposes paid in full for a youth survivor of gun violence under this chapter shall not be eligible for reimbursement or payment by the board for the same purposes.
(i) The department shall annually issue a public report, to be posted on its internet website, on the impact of the T.H.R.I.V.E. grant program, key conclusions, populations served, and the benefits conferred or realized, using quantitative and qualitative data. The department may require grantees to maintain and submit nonidentifying data about program implementation for the purpose of compiling a report under this subdivision, but shall not require grantees to submit any information that could identify individual youth survivors of gun violence or their family members.
(j) This section shall be implemented only to the extent that funds are provided from the fund for purposes of this section. This section does not obligate any county or city and county to use funds from any other source for services pursuant to this section.
(k) The department shall develop a formula to determine the amount of funds to be allocated to each grantee, using data from the most recent three-year period to estimate the number of youth survivors of gun violence in each county or city and county, and allocating funds proportionally based on those numbers.

8273.
 (a) The Trauma Healing and Resilience Investment for Victimized and Exposed Youth Fund is hereby created within the State Treasury. Moneys deposited into the fund, upon appropriation by the Legislature, may be expended by the department for the purposes of this chapter.
(b) The department may enter into agreements with one or more entities to facilitate the implementation of the T.H.R.I.V.E. grant program, which may not exceed 5 percent of funds appropriated for purposes of this chapter, including, but not limited to, any of the following:
(1) Providing technical assistance to grantees and community-based organizations receiving funding pursuant to this chapter.
(2) Conducting outreach or supporting grantees to conduct outreach to youth and families who may be eligible for the program.
(3) Evaluating T.H.R.I.V.E. grant program data and information and preparing the public report described in Section 8272.
(c) Notwithstanding subdivision (b), the department shall not expend more than 5 percent of funds appropriated for purposes of this chapter on its administrative costs.
(d) It is the intent of the Legislature to appropriate funds annually for the purposes of this chapter that are sufficient to pay for every youth survivor of gun violence in California to receive a minimum of one year of mental health and counseling services at an amount of seven thousand eight hundred dollars ($7,800) per survivor, per year.

8274.
 (a) Contracts or grants awarded pursuant to this chapter shall be exempt from the personal services contracting requirements of Article 4 (commencing with Section 19130) of Chapter 5 of Part 2 of Division 5 of Title 2 of the Government Code.
(b) Contracts or grants awarded pursuant to this chapter shall be exempt from the Public Contract Code and the State Contracting Manual, and shall not be subject to the approval of the Department of General Services.
(c) The client information and records of mental health services provided pursuant to this chapter shall be confidential and shall be exempt from inspection under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(d) The state shall be immune from any liability resulting from the implementation of this chapter.
(e) Notwithstanding 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), the department may implement and administer this chapter through all-county letters or similar instruction that shall have the same force and effect as regulations.

SEC. 4.

 The Legislature finds and declares that Section 3 of this act, which adds Chapter 9 (commencing with Section 8270) to Division 8 of the Welfare and Institutions Code, imposes a limitation on the public’s right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by this limitation and the need for protecting that interest:
In order to protect the privacy and safety concern of victims of violent crime, and to provide records relating to private health care services, it is necessary that this act limit the public’s right of access to that information.

SEC. 5.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.
SECTION 1.Section 13955 of the Government Code is amended to read:
13955.

Except as provided in Section 13956, a person shall be eligible for compensation when all of the following requirements are met:

(a)The person for whom compensation is being sought is any of the following:

(1)A victim.

(2)A derivative victim.

(3)(A)A person who is entitled to reimbursement for funeral, burial, or crime scene cleanup expenses pursuant to paragraph (9) or (10) of subdivision (a) of Section 13957.

(B)This paragraph applies without respect to any felon status of the victim.

(b)Either of the following conditions is met:

(1)The crime occurred in California. This paragraph applies only during those time periods during which the board determines that federal funds are available to the state for the compensation of victims of crime.

(2)Whether or not the crime occurred in California, the victim was any of the following:

(A)A resident of California.

(B)A member of the military stationed in California.

(C)A family member living with a member of the military stationed in California.

(c)If compensation is being sought for a derivative victim, the derivative victim is a resident of California, or any other state, who is any of the following:

(1)At the time of the crime was the parent, grandparent, sibling, spouse, child, or grandchild of the victim.

(2)At the time of the crime was living in the household of the victim.

(3)At the time of the crime was a person who had previously lived in the household of the victim for a period of not less than two years in a relationship substantially similar to a relationship listed in paragraph (1).

(4)Is another family member of the victim, including, but not limited to, the victim’s fiancé or fiancée, and who witnessed the crime.

(5)Is the primary caretaker of a minor victim, but was not the primary caretaker at the time of the crime.

(d)The application is timely pursuant to Section 13953.

(e)(1)Except as provided in paragraph (2), the injury or death was a direct result of a crime.

(2)Notwithstanding paragraph (1), no act involving the operation of a motor vehicle, aircraft, or water vehicle that results in injury or death constitutes a crime for the purposes of this chapter, except when the injury or death from such an act was any of the following:

(A)Intentionally inflicted through the use of a motor vehicle, aircraft, or water vehicle.

(B)Caused by a driver who fails to stop at the scene of an accident in violation of Section 20001 of the Vehicle Code.

(C)Caused by a person who is under the influence of any alcoholic beverage or drug.

(D)Caused by a driver of a motor vehicle in the immediate act of fleeing the scene of a crime in which they knowingly and willingly participated.

(E)Caused by a person who commits vehicular manslaughter in violation of subdivision (b) of Section 191.5, subdivision (c) of Section 192, or Section 192.5 of the Penal Code.

(F)Caused by any party where a peace officer is operating a motor vehicle in an effort to apprehend a suspect, and the suspect is evading, fleeing, or otherwise attempting to elude the peace officer.

(f)As a direct result of the crime, the victim or derivative victim sustained one or more of the following:

(1)Physical injury. The board may presume a child who has been the witness of a crime of domestic violence has sustained physical injury. A child who resides in a home where a crime or crimes of domestic violence have occurred may be presumed by the board to have sustained physical injury, regardless of whether the child has witnessed the crime.

(2)Emotional injury and a threat of physical injury.

(3)Emotional injury, where the crime was a violation of any of the following provisions:

(A)Section 236.1, 261, former Section 262, 271, 273a, 273d, 285, 286, 287, 288, former Section 288a, Section 288.5, 289, or 653.2 of, or subdivision (b) or (c) of Section 311.4 of, the Penal Code.

(B)Felony violations of subdivision (a) of Section 187 of, Section 203, 206, 207, 209, 209.5, 210, 220, 264.1, 269, 288.7, or 646.9 of, or any crime punishable pursuant to Section 667.61 or 667.71 of, or attempted violations of Section 187 of, the Penal Code.

(C)Section 270 of the Penal Code, where the emotional injury was a result of conduct other than a failure to pay child support, and criminal charges were filed.

(D)Section 261.5 of the Penal Code, and criminal charges were filed.

(E)Section 278 or 278.5 of the Penal Code, and criminal charges were filed. For purposes of this paragraph, the child, and not the nonoffending parent or other caretaker, shall be deemed the victim.

(4)Injury to, or the death of, a guide, signal, or service dog, as defined in Section 54.1 of the Civil Code, as a result of a violation of Section 600.2 or 600.5 of the Penal Code.

(5)Emotional injury to a victim who is a minor incurred as a direct result of the nonconsensual distribution of pictures or video of sexual conduct in which the minor appears.

(g)The injury or death has resulted or may result in pecuniary loss within the scope of compensation pursuant to Sections 13957 to 13957.7, inclusive.