California § 1371.51 - A health care service plan contract issued, amended, or renewed on or after July

§ 1371.51. A health care service plan contract issued, amended, or renewed on or after July

(a) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program. (b) (1) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall require an enrollee who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program. (2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health care service plan’s usual and customary charges for services rendered. (c) For purposes of this section, the following definitions apply: (1) “Community paramedicine program” means a program defined in Section 1815. (2) “Mobile integrated health program” means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system. (3) “Triage to alternate destination program” means a program defined in Section 1819.