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AB 2353

Health Mandates Review Program.

2025-2026 Regular Session Introduced by Blanca Pacheco and 3 co-sponsors

AB 2353 establishes a UC-run Health Mandates Review Program to rigorously analyze the cost, hospital impact, and affordability of proposed hospital-related mandates before enactmen

In committee: Set, first hearing. Hearing canceled at the request of author.
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Bill Summary · AB 2353

Summary of AB 2353 (2025-2026) — Health Mandates Review Program

Scope: California Health and Safety Code amendments to create a new program that analyzes the cost and broader impacts of proposed mandates on hospital services and provider activities, with dedicated funding and reporting requirements. Introduced by Assembly Member Pacheco, with coauthors P-Norris and co-sponsorships.

1) Purpose and Intent

  • Main purpose: Establish an independent, nonpartisan Health Mandates Review Program to systematically review proposed legislation that would require new or additional services or activities by health care providers, particularly those affecting hospitals.
  • Rationale: While some mandated services could improve public health, mandates drive up costs and affect affordability. The bill creates a formal mechanism to assess costs, health impacts, and hospital financial stability before enactment, aiding lawmakers in determining public-interest suitability.
  • Legislative goals include ensuring access to affordable, high-quality, and equitable health care and providing current, credible data to evaluate proposed legislation.

2) Key Provisions and Changes

  • California Health Mandates Review Program (CHMRP)

    • To be established by the University of California (UC) to assess legislation mandating new or additional hospital services or activities (for hospitals, not general health benefits).
    • Program start date: Beginning no later than January 1, 2028.
    • Each analysis must include:
    • Hospital care delivery impacts
    • Public health impacts
    • Financial impacts (costs, utilization, administrative expenses, premiums, etc.)
    • Impacts on total health care costs and potential year-one and long-range (two-year) forecasts
    • Impacts across payer types (Medi-Cal, Medicare, and commercial payers) when feasible
    • Assessment of whether mandated services would affect access to other services
    • Comparisons to alternatives, including not implementing the mandate
    • Use of a certified actuary or equivalent expertise for financial impact evaluations
    • Analyses to be provided to the relevant policy or fiscal committees no later than 72 hours before the estimated hearing in the originating house, or as otherwise agreed.
    • The program may contract with other entities as needed to perform analyses.
    • Annual summary: Publish a summary of enacted hospital-related mandates analyzed during the year and their cost/impact if a written analysis was conducted.
    • Workgroup: Convene a paid or advisory workgroup with hospital finance/operations expertise to guide program development and implementation.

  • Health Mandates Fund

    • A new dedicated fund in the State Treasury to support UC’s Health Mandates Review Program and related bill analyses.
    • Transfer mechanism: Beginning in 2027–28, the Department of Health Care Access and Information shall transfer funds from the California Health Data and Planning Fund to the Health Care Mandates Fund (exact amount to be determined by regulation).
    • Budget cap: For 2026–27 through 2032–33, annual assessments on health care service plans (excluding specialized plans) and health insurers to fund UC analyses shall be set by regulation and capped at $3,200,000 total per year.
    • Assessment administration: Managed by the Department of Managed Health Care (for plans) and the Department of Insurance (for insurers) in coordination with UC.
    • Payment timing: Assessments due by August 1 each year; notices issued by June 15 (separate from other statutory assessments); funds transferred to the State Controller for deposit to the Health Care Benefits Fund.

  • Funding sources and governance

    • Establishes a Health Care Benefits Fund to support UC’s health-benefit analyses under existing CHBRP-like structures, updated to reflect the new mandate-focused program.
    • The bill clarifies that health insurance definitions exclude certain products (e.g., Medicare supplement, vision-only, dental-only, CHAMPUS supplements, etc.) from the assessment base.
    • Explicit prohibition on creating a state independent review board for full data access to payer databases and hospital discharge data as part of this program (data access constraints remain).

  • Relationship to CHBRP

    • The bill builds on the existing California Health Benefit Review Program (CHBRP) framework by adding a parallel, hospital-focused cost-and-impact review process.
    • It clarifies UC’s role in producing analyses but adds the hospital-centric mandate review and associated funding.

3) Who Would Be Affected

  • Hospitals and hospital systems: Primary focus of the new program; analyses will consider staffing costs, capital improvements, equipment, facility changes, and impact on operations.
  • Health plans and health insurers: Subject to annual assessments to fund the program; analyses may consider payer impacts and premium implications.
  • UC and the California Health Benefit Review Program: Expanded role and new funding to support the Health Mandates Review Program.
  • Department of Managed Health Care and Department of Insurance: Responsible for administering annual assessments.
  • Legislature (policy and fiscal committees): Receives written analyses; required to rely on these analyses for evaluating hospital-related mandates.
  • General public: Access to annual summaries of hospital-related mandates and their cost/impact, enabling more informed public discussions.

4) Procedural and Timeline Aspects

  • Start of Health Mandates Review Program: No later than January 1, 2028.
  • Trigger for analysis: When a bill is anticipated to affect hospital operations (e.g., staffing, equipment, facilities, or discounted/charitable care requirements) as identified by the legislature’s origin house committees.
  • Analysis delivery: Written analysis due to committees not less than 72 hours before the fiscal committee hearing in the house of origin; timeline may be adjusted by legislative consent.
  • Annual reporting: By December 31 each year, publish a summary of analyzed hospital mandates enacted that year and their cost impacts (if a written analysis was completed).
  • Funding: Annual fee-based funding mechanism for plans and insurers, capped at $3.2 million total per year, with funds transferred to UC for program implementation; additional transfer from the California Health Data and Planning Fund to support the Health Mandates Fund starting 2027–28.
  • Advisory workgroup: A hospital-finance/operations-oriented workgroup will advise on program development and implementation.

Overall, AB 2353 creates a rigorous, data-driven framework to evaluate the costs and consequences of hospital-related mandates before they become law, ensuring lawmakers have thorough analyses to balance health outcomes with affordability.

Compiled from official sources — confirm details with the bill’s official record.

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