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CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION

95

Introduced by Assembly Member Sharp-Collins

(Coauthor: Assembly Member Addis)

February 20, 2026

An act to amend Section 1373.65 of the Health and Safety Code, relating to health care.

Vote: majority   Appropriation: no   Fiscal committee: yes   Local program: yes

LEGISLATIVE COUNSEL’S DIGEST

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’s requirements a crime. Existing law requires a health care service plan to notify an enrollee by United States mail at least 60 days before the termination date of a contract between a health care service plan and a provider group or a general acute care hospital to which the enrollee is assigned. If the plan reaches an agreement with a terminated provider after sending that notice, existing law requires the plan to offer each affected enrollee the option to return to that provider and to reassign the enrollee to another provider if the enrollee does not exercise that option.

This bill would additionally require a health care service plan to notify an enrollee by email or text message, as specified and only if the enrollee has opted in and provided their contact information, at least 60 days before the termination date of a contract between a health care service plan and a provider group or a general acute care hospital to which the enrollee is assigned. If the plan reaches an agreement with a terminating or terminated provider after sending the notice of termination, the bill would require the health care service plan to send written notice by United States mail and by email or text message, as specified and only if the enrollee has opted in and provided their contact information, to affected enrollees within 60 days of reaching the agreement. no later than 10 business days after department approval of the notice. If the agreement is to renew, enter into a new contract, or to not terminate their contract before the termination date in the notice of termination, the bill would require the health care service plan to notify enrollees that they will remain assigned to the provider. If the agreement is to renew, enter into a new contract, or to not terminate their contract after the termination date in the notice of termination, the bill would require the health care service plan to notify and offer each affected enrollee the option to return to that provider. The bill would require a health care service plan to submit these notices to the department for approval within 5 business days of reaching an agreement. Because a willful violation of these provisions would be a crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

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

SECTION 1.

Section 1373.65 of the Health and Safety Code is amended to read:

1373.65.

(a) At least 75 days before the termination date of its contract with a provider group or a general acute care hospital, the health care service plan shall submit an enrollee block transfer filing to the department that includes the written notice the plan proposes to send to affected enrollees. The plan may not send this notice to enrollees until the department has reviewed and approved its content. If the department does not respond within seven days of the date of its receipt of the filing, the notice shall be deemed approved.

(b) (1) At least 60 days before the termination date of a contract between a health care service plan and a provider group or a general acute care hospital, the plan shall send the written notice described in subdivision (a) by United States mail to enrollees who are assigned to the terminated terminating provider group or hospital. assigned to a provider group that has admitted at least one enrollee to the terminating general acute care hospital within the past 12 calendar months of the health care service plan’s block transfer filing.

(2) In addition to sending written notice by United States mail, the health care service plan shall send the written notice to the enrollee electronically at least 60 days before the termination date of the contract via either of the following methods:

(A) Text message to the preferred or last known cell phone number of the enrollee.

(B) Email to the preferred or last known email address of the enrollee.

(3) The electronic notification pursuant to paragraph (2) applies only if the enrollee has opted in to electronic delivery as their communication preference and has included the contact information described in subparagraphs (A) and (B) of paragraph (2).

(4) A plan that is unable to comply with the timeframe described in paragraph (1) because of exigent circumstances shall apply to the department for a waiver. The plan is excused from complying with this requirement only if its waiver application is granted by the department or the department does not respond within seven days of the date of its receipt of the waiver application. If the terminated terminating provider is a hospital and the plan assigns enrollees to a provider group with exclusive admitting privileges to the hospital, the plan shall send the written notice to each enrollee who is a member of the provider group and who resides within a 15-mile radius of the terminated terminating hospital. If the plan operates as a preferred provider organization or assigns members to a provider group with admitting privileges to hospitals in the same geographic area as the terminated hospital, the plan shall send the written notice to all enrollees who reside within a 15-mile radius of the terminated terminating hospital.

(c) The health care service plan shall send enrollees of a preferred provider organization the written notice required by subdivision (b) only if the terminated terminating provider is a general acute care hospital.

(d) If an individual provider terminates the provider’s contract or employment with a provider group that contracts with a health care service plan, the plan may require that the provider group send the notice required by subdivision (b).

(e) (1) If, after sending the notice required by subdivision (b), a health care service plan reaches an agreement with a terminated terminating provider to renew or enter into a new contract or to not terminate their contract, the plan shall notify and offer each affected enrollee the option to return to that provider in accordance with paragraph (2). contract before the termination date specified in the notice required by subdivision (b), the plan shall notify each affected enrollee of the agreement and notify enrollees that they will remain assigned to the provider to whom the enrollee was assigned prior to the notices sent by the plan as required in subdivision (b).

(4) Within 60 five business days of reaching the agreement described in paragraph (1), an agreement described in paragraph (1) or (2), the health care service plan shall submit to the department the written notice described in paragraph (1) or (2) for approval. No later than 10 business days after department approval, the plan shall send written notice by United States mail to affected enrollees. enrollees who received the notice required by subdivision (b). In addition to sending written notice by United States mail, the health care service plan shall send written notice to the enrollee electronically within 60 days of reaching the agreement no later than 10 business days after department approval via either of the following methods:

(A) Text message to the preferred or last known cell phone number of the enrollee.

(B) Email to the preferred or last known email address of the enrollee.

(5) The electronic notification pursuant to paragraph (2) (4) applies only if the enrollee has opted in to electronic delivery as their communication preference and has included the contact information described in subparagraphs (A) and (B) of paragraph (2). (4).

(f) A health care service plan and a provider shall include in all written, printed, or electronic communications sent to an enrollee that concern the contract termination or block transfer, the following statement in not less than 8-point type: 12-point type: “If you have been receiving care from a health care provider, you may have a right to keep your provider for a designated time period. Please contact your health plan’s customer service department, and if you have further questions, you are encouraged to contact the Department of Managed Health Care, which protects consumers, by telephone at its toll-free number, 1-888-466-2219, or at a TDD number for the hearing and speech impaired at 1-877-688-9891, or online at www.dmhc.ca.gov.”

(g) For purposes of this section, “provider group” means a medical group, independent practice association, or any other similar organization.

SEC. 2.

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