Sensitive Services
Provider Type
- Physicians and Practitioners
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Sensitive services include those services related to treatment for injuries resulting from sexual assault, drug or alcohol abuse treatment, pregnancy, family planning, HIV counseling and testing, pregnancy termination, outpatient mental health treatment and diagnosis, residential shelter services, intimate partner violence, and treatment of sexually transmitted infections (STIs) for children under age 18.
Reproductive rights, privacy and the exchange of information
The Reproductive Privacy Act guarantees individuals a fundamental right to privacy regarding their reproductive choices, preventing the state from denying or interfering with a person's right to choose or obtain an abortion before the fetus is viable or when the abortion is necessary to protect the person's life or health.1
Certain businesses handling medical information on sensitive services must develop security policies for data related to gender-affirming care, abortion, abortion-related services, and contraception. California law also prohibits health care providers, plans, contractors, or employers from sharing medical information for investigations or inquiries from other states or federal agencies regarding lawful abortions unless authorized by existing law.
Data for gender-affirming and abortion-related services must be omitted from data exchanged via health information exchanges (HIEs) and not be transmitted to California HIEs.
State law specifically states:1
- A business that electronically stores or maintains medical information on the provision of sensitive services, including, but not limited to, on an electronic health record system or electronic medical record system, on behalf of a provider of health care, health care service plan, pharmaceutical company, contractor, or employer, must have capabilities, policies, and procedures that enable all of the following:
- Limit user access privileges to information systems that contain medical information related to gender affirming care, abortion and abortion-related services, and contraception only to those persons who are authorized to access specified medical information.
- Prevent the disclosure, access, transfer, transmission, or processing of medical information related to gender affirming care, abortion and abortion-related services, and contraception to persons and entities outside of the state of California.
- Segregate medical information related to gender affirming care, abortion and abortion-related services, and contraception from the rest of the patient’s record.
- Provide the ability to automatically disable access to segregated medical information related to gender affirming care, abortion and abortion-related services, and contraception by individuals and entities in another state.
Additionally, state law prohibits the collection or disclosure of information outside California for operational claims payment purposes. State law includes requirements for provider licensing, enhanced protections for individuals and providers in sensitive services and "legally protected health care activity," including preventing the disclosure of medical information related to sensitive services outside the state, segregating such information from the patient's record, and enabling automatic disabling of access by entities outside the state.
Legally protected health care activity includes, but is not limited to:
- Reproductive health care services,
- Gender-affirming health care services, and
- Gender-affirming mental health care services.
Sensitive services include, but are not limited to:
- Services related to mental/behavioral health,
- Sexual and reproductive health,
- Sexually transmitted infections,
- Substance use disorder,
- Gender affirming care, and
- Intimate partner violence.
Requirements for providers
Physicians and other health care providers must incorporate and/or adhere to the following:
- Specified businesses that store or maintain medical information regarding sensitive services must develop specific policies, procedures and capabilities that protects sensitive information.
- Health care service plans, providers and others may not cooperate with any inquiry or investigation from any individual, outside state, or federal agency that would identify an individual that is seeking, obtaining, or has obtained an abortion or related services that are lawful in California. Exceptions may be authorized if the individual has provided authorization for the disclosure.
- The exchange of health information related to abortion and abortion-related services is excluded from automatically being shared on the California Health and Human Services Data Exchange Framework.
1Information taken or derived from Assembly Bill 352, Senate Bill 345, or information at https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB352 or https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240SB345.
Impacts of regulations on business, business partners, or members
- Regulations prohibit healing arts boards from denying an application for a license, or from imposing discipline on a licensee, on the basis of a civil judgment, criminal conviction or disciplinary action in another state if that judgment is based solely on the application of another state’s law that interferes with a person’s right to receive sensitive services.
- The practice of nurse-midwifery includes care for common gynecologic conditions and (when certified by a physician or surgeon) to furnish or order Schedule II and III controlled substances as specified.
- Regulations prohibit a person or business from collecting, using, disclosing, or retaining the personal information of a person who is physically located at or within a precise geolocation of a family planning center.
- Regulations repeal current state provisions that:
- Prohibit an abortion from being performed upon an unemancipated minor unless they have first given written consent to the abortion and also has obtained the written consent of one parent or legal guardian.
- Provide specified judicial procedures when consent of a parent or guardian cannot be obtained by the pregnant unemancipated minor.
Rape and sexual assault
Rape and sexual assault could also be inferred as “intimate partner violence” and would also be identified as a sensitive service.
SECTION 1. Section 56.05 of the Civil Code is amended to read:
56.05. For purposes of this part:
(n) “Sensitive services” means all health care services related to mental or behavioral health, sexual and reproductive health, sexually transmitted infections, substance use disorder, gender affirming care, and intimate partner violence, and includes services described in Sections 6924, 6925, 6926, 6927, 6928, 6929, and 6930 of the Family Code, and Sections 121020 and 124260 of the Health and Safety Code, obtained by a patient at or above the minimum age specified for consenting to the service specified in the section.
Coverage
Health Net covers emergency room care and follow-up medical treatment without any member cost share for members who have suffered rape or sexual assault.
Members may obtain any of the following services for rape or sexual assault without any member cost share from the start of treatment:
- Emergency room care.
- Follow-up treatments, including any medical or surgical services for the diagnosis, prevention or treatment of medical conditions arising from an instance of rape or sexual assault.
- Mental health treatments.
- Out-of-network services if medically necessary care is not available within the member’s network.
Medi-Cal only: No prior authorization needed for services from non-participating providers
As a part of the Medi-Cal covered benefit, Medi-Cal members may access care from non-participating providers for sensitive services without prior authorization.
How to bill for services
Providers may use standard diagnosis codes recognized by Health Net that pertain to rape or sexual assault following Billing and Submission requirements. Health Net requires that the ICD-10 Dx code is visible on the face of the paper-based prescription when pharmacist is filling the prescription. For electronic scripts, providers are responsible for determining where to place this information, based on their Electronic Medical Record (EMR) system.
If you have questions on how or where to place the Dx code, please contact your EMR vendor for information. Please note that any prescriptions given for member care will need to include the relevant diagnosis code(s).
HIV test result disclosure
- Providers may disclose HIV test results that identify Medi-Cal beneficiaries to:
- The member’s assigned Medi-Cal Managed Care Plan (MCP).
- External quality review organizations contracted by the California Department of Health Care Services (DHCS).
These disclosures are permitted for quality improvement activities, including value-based payment and healthy behavior incentive programs. Written patient authorization is not required for these disclosures.
Disclosure of non-identifying HIV test results
- MCPs may share HIV test results that do not identify Medi-Cal patients with the DHCS staff for quality improvement purposes. Written patient authorization is not required for these disclosures.
Restrictions on disclosure
- Disclosure of identifying HIV test results to other health care service plans (not the assigned Medi-Cal MCP) requires written authorization from the patient or their representative.
- Disclosure to federal agencies or authorities in other states is only permitted when required by federal law.