State Budget — Enacted
The California Legislature passed the 2026–27 state budget on June 15, 2026, meeting the constitutional deadline, with the remaining budget trailer bills — including the MCO tax reauthorization and Proposition 35 provider reimbursement implementation — finalized ahead of the June 30 statutory deadline. t is still unclear CMS will approve the newly designed MCO Tax structure. CASA will continue to monitor rate-setting guidance issued under Prop. 35 as it affects specialty and ambulatory surgery reimbursement.
Legislative Calendar — Deadlines
The Legislature is currently in Summer Recess. The stretch between reconvening on August 3rd and the August 30th end of session represents the final and most intensive period of legislative activity this year. Bills that have not cleared both houses by August 30th are dead for the year, and the Governor then has until September 30th to sign or veto enrolled legislation.
|
Date |
Milestone |
Status |
|
June 15, 2026 |
State budget bill passed |
✓ Complete |
|
June 30, 2026 |
Budget trailer bill deadline; statutory balanced budget deadline |
✓ Complete |
|
July 2, 2026 |
Legislature began Summer Recess |
✓ Complete — Legislature currently in recess |
|
August 3, 2026 |
Legislature reconvenes from Summer Recess |
Today |
|
August 14, 2026 |
Last day for fiscal bills to be heard (Suspense Deadline) |
Upcoming – key deadline |
|
August 30, 2026 |
End of Session — final deadline for legislative action on all bills |
Upcoming – key deadline |
|
September 30, 2026 |
Governor's deadline to sign or veto all bills reaching his desk |
Upcoming – key deadline |
CASA is tracking all priority bills closely heading into the August floor sessions and will issue an end-of-session summary once final disposition on each bill is known.
CASA's remaining priority bills survived their first-house or policy-committee votes and are now moving through fiscal committee review, with most calendared for the August 3rd Senate Appropriations hearing - the first order of business when the Legislature reconvenes from recess. Each bill is expected to be referred to its respective Appropriations Suspense File and, if released, will advance to the Assembly or Senate Floor for a vote following the Appropriations Suspense File hearing on August 14.
Artificial Intelligence
|
Bill / Author |
What It Does |
Status / Next Step |
Position / Notes |
|
AB 1979 (Bonta, D) Health care chatbots — CMIA coverage |
Would classify businesses that offer AI health care chatbots to consumers as "providers of health care," subjecting them to the same confidentiality obligations as other providers under the CMIA. |
07/02/26 — Amended and passed Senate policy committee 8-0; re-referred to Senate Appropriations. Calendar: 08/03/26 Senate Appropriations |
Watch — CMA, CHA, other provider groups, and CalChamber opposed |
|
AB 2575 (Ortega, D) Clinical decision support systems |
Would require health facilities and physician practices using AI clinical decision support tools to maintain an inventory of those systems, disclose how they generate outputs upon request, and notify staff annually of that right. |
06/29/26 — Passed Senate policy committee 6-2; re-referred to Senate Appropriations. Calendar: 08/03/26 Senate Appropriations |
Watch — CMA, CHA, other provider groups, and CalChamber opposed |
|
SB 1146 (Gonzalez, D) Digital replicas in health ads |
Would require health-related ads using an AI-generated digital replica or synthetic performer depicted as a health care provider to clearly disclose that the provider shown is AI-generated or that no real provider appears. |
06/23/26 — Passed Assembly policy committee 11-1; re-referred to Assembly Appropriations |
Watch — CMA-sponsored bill; CDA supports |
Medi-Cal
|
Bill / Author |
What It Does |
Status / Next Step |
Position / Notes |
|
AB 2729 (Bonta, D) Medi-Cal Trust Fund (spot bill) |
Would continuously appropriate funds to help the state administer Medi-Cal and preserve coverage and access to care in response to federal Medicaid changes under Public Law 119-21, effective only if those federal provisions aren't repealed before January 1, 2027. |
05/19/26 — Re-referred to Assembly Appropriations; no further action since |
Watch — response to federal Medicaid changes under PL 119-21 |
Other Priority Bills
|
Bill / Author |
What It Does |
Status / Next Step |
Position / Notes |
|
AB 1776 (Aguiar-Curry, D) Cartwright Act antitrust |
Would prohibit unreasonably restraining trade, monopolizing, or monopsonizing any part of California commerce, and would require courts to apply the rule-of-reason framework from In re Cipro Cases I & II — broadening antitrust enforcement tools. |
07/01/26 — Passed Senate policy committee 9-2; re-referred to Senate Appropriations. Calendar: 08/03/26 Senate Appropriations |
Watch — CalChamber and other business entities opposed |
|
AB 1868 (Hadwick, R) Cardiac surgery standards |
Would require the State Department of Public Health, by January 1, 2030, to update its cardiac surgical-team regulations to reflect current professional standards of care for extracorporeal bypass procedures. |
06/25/26 — Passed Senate policy committee 11-0 with recommendation for the Consent Calendar; re-referred to Senate Appropriations. Calendar: 08/03/26 Senate Appropriations |
Tracking — cardiology nexus |
|
AB 2301 (Soria, D) BSN Nursing Pilot Program |
Would create a 10-district pilot letting select community colleges offer a Bachelor of Science in Nursing degree, prioritizing enrollment for students who already hold an associate nursing degree, with LAO evaluation by 2034. |
07/02/26 — Passed Senate policy committee 7-0; re-referred to Senate Appropriations. Calendar: 08/03/26 Senate Appropriations |
Potential support — workforce pipeline for ambulatory surgery |
Prior Authorization
|
Bill / Author |
What It Does |
Status / Next Step |
Position / Notes |
|
SB 964 (Smallwood-Cuevas, D) Dose adjustments without PA |
Would let a patient's treating provider adjust the dose or frequency of a previously approved prescription drug to meet the patient's medical needs without obtaining new prior authorization, when specified conditions are met. |
06/24/26 — Heard and placed on the Assembly Appropriations suspense file |
Watch — strong momentum; no opposition noted to date |
Reimbursements
|
Bill / Author |
What It Does |
Status / Next Step |
Position / Notes |
|
SB 1049 (Weber Pierson, D) 90-day corrected claim window |
Would give providers 90 days to submit a corrected claim after a health plan or insurer denies a claim or sends an overpayment notice, and would bar plans from denying a corrected claim solely because it missed another filing deadline. |
06/24/26 — Coauthors revised; passed Assembly policy committee 15-0; re-referred to Assembly Appropriations |
Support — CHA and other provider groups support; health plans opposed |
A Fast-Moving Gut-and-Amend, and CASA's Rapid Response
AB 225 (Bonta) illustrates how quickly a bill can move in Sacramento — and why CASA's ability to respond fast matters. As introduced in 2025, AB 225 was an unrelated measure concerning patient trust funds at state mental health hospitals. In early June, the author gutted and amended the bill, replacing its original subject matter entirely with new language prohibiting health care providers, hospitals, and health systems from charging facility fees for a broad range of outpatient services, including preventive care.
The bill moved on an accelerated timeline through the Senate, being amended and re-referred to the Senate Health Committee to be hear in its new form. As drafted, the bill's facility fee prohibition swept in preventive screenings – including screening colonoscopies – performed in ambulatory surgery centers, without accounting for the operating room, anesthesia, equipment, staffing, and monitoring costs that make those procedures possible in an outpatient setting.
Because the amended language emerged so close to the Committee's hearing date, CASA had a narrow window to act. CASA’s leadership team and advocates turned around a formal opposition letter to Senate Health Committee Chair, in parallel with other provider organizations expressing similar concerns. The letter laid out the clinical and cost realities of screening colonoscopies performed in ASCs and warned that the bill, as drafted, would push preventive screenings into higher-cost hospital settings – directly undermining the state's colorectal cancer screening and early-detection goals.
Due to CASA’s advocacy, at least in part, AB 225 did not advance out of the Senate Health Committee and will not advance through the legislative process this year. CASA will continue to monitor the bill for any renewed movement or amendments when the Legislature reconvenes on August 3rd, given the subject matter could resurface before the August 30th end-of-session deadline, albeit unlikely.
CASA's Comments Remain Pending as Rulemaking Continues
CASA continues to actively engage in Cal/OSHA's rulemaking on occupational exposure to surgical plume under AB 1007. As previously reported, CASA formally submitted written comments to the Cal/OSHA Regulatory Services Unit on May 27, 2026, in response to the agency's April 2026 revised discussion draft of proposed § 51XX.
Since that filing, the California Hospital Association submitted its own comment letter on June 1, 2026, reiterating that the latest discussion draft still does not resolve concerns first raised in CHA's September 2025 letter – reinforcing that CASA is not alone among provider groups pressing Cal/OSHA to revise the current approach. As of this update, Cal/OSHA has not released a further revised draft or scheduled a new advisory committee meeting; the agency remains under a statutory deadline to propose formal rulemaking text by December 1, 2026, with adoption anticipated sometime in 2027.
CASA's core requests remain unchanged and continue to be the association's focus in ongoing conversations with Cal/OSHA staff:
CASA will notify members as soon as Cal/OSHA schedules its next advisory committee meeting or releases updated regulatory text. Members with operational questions about the proposed standard are encouraged to contact CASA staff.
State's Emergency CMIR Regulations Remain in Effect
The Office of Health Care Affordability (OHCA), housed within the Department of Health Care Access and Information (HCAI), continues to implement its emergency regulatory amendments to the Cost and Market Impact Review (CMIR) process – the state's oversight framework for material change transactions involving health care entities. CASA continues to monitor this regulatory area given its implications for ASC ownership, affiliation, and transaction activity, including expanded filing triggers for private equity and management services organization transactions, and the 45/60/90-day OHCA review timelines under 22 CCR § 97431 et seq.
Members contemplating transactions involving affiliations, acquisitions, or management arrangements are encouraged to consult with legal counsel to assess whether OHCA notice obligations may apply.
Becerra Holds Wide Lead Over Hilton Heading Into the Fall
With the June primary behind us, a new Public Policy Institute of California (PPIC) survey conducted June 29–July 6, 2026 shows Democrat Xavier Becerra leading Republican Steve Hilton 61% to 36% in the general election matchup for Governor. The poll surveyed 1,578 California adults, including 1,003 likely voters, and found Becerra leading across age, gender, homeownership, income, and racial/ethnic groups, as well as across the state's major regions.
As the two general-election candidates begin building out their platforms ahead of November, CASA will monitor both campaigns for statements on health care affordability, hospital and ASC regulation, and scope-of-practice issues relevant to ambulatory surgery, and will keep members apprised of any positions that bear on the association's legislative and regulatory priorities.
Guidance on Required Remittance Advice Remark Codes Related to the No Surprises Act
On June 4, 2026, the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services (the Departments), along with the Office of Personnel Management (OPM), published the Federal Independent Dispute Resolution Operations final rules to improve the functioning of the Federal Independent Dispute Resolution (IDR) process established under the No Surprises Act. These final rules establish new requirements for plans and issuers to use claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs), which are standardized codes that convey information about claims processing, in the manner and timeframe specified in guidance issued by the Departments, when providing remittance advice for items and services furnished under certain circumstances. CARCs explain why a claim or service line was paid differently from how it was billed, and RARCs provide additional explanation for the remittance.
The guidance released on July 17, 2026, specifies the RARCs to be used for purposes of the final regulations, the circumstances in which each RARC is to be used, and technical instructions to facilitate their use. Use of the specified RARCs in the circumstances detailed in this guidance and any related future guidance will satisfy the requirements related to the use of CARCs and RARCs under the final regulations. Plans and issuers may continue to use the CARC they deem most appropriate for any claim adjustment. The requirement to provide CARCs and RARCs in the manner, circumstances, and timeframe specified in this guidance applies for items and services furnished on or after January 1, 2027.
View the guidance here: https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/caa-nsa-rarc-codes.pdf
How Do I Comment on the CY 2027 Proposed Rule?
The proposed rule includes directions for submitting comments within the 60-day comment period. Comments must be submitted by Monday, September 14, 2026.
When commenting, refer to file code: CMS-1848-P
Use 1 of the 3 following ways to officially submit your comments:
Additional Resources
Learn more about QPP proposals in the following resources: