California SB 464: Implicit Bias Training Rules and Deadlines

California’s SB 464, the Dignity in Pregnancy and Childbirth Act, requires every hospital and birth facility that provides perinatal care to put its clinicians and patient-facing staff through an evidence-based implicit bias course covering ten specified topics, refresh that training at least every two years, and, under the 2024 amendments in AB 2319, report compliance directly to the Attorney General. The implicit bias training requirements in SB 464 California law took full effect on a phased schedule: existing providers had to complete the initial course by June 1, 2025, and the first facility compliance report is due February 1, 2026.

Which Facilities and Workers Are Covered

The training obligation runs to any hospital that provides perinatal care, plus alternative birth centers and primary care clinics that offer birthing services.¹ “Perinatal care” in the statute reaches the full arc of pregnancy care: prenatal visits, labor and delivery, and the postpartum and neonatal periods.²

Two categories of workers within those facilities must be trained. The first is anyone licensed under California’s health-care licensing laws who is regularly assigned to perinatal care, whether in a labor and delivery unit, an outpatient clinic, or an emergency department. The second is staff who regularly interact with perinatal patients even when they aren’t the treating clinician, such as medical assistants and licensed vocational nurses.¹

Physicians who provide perinatal care at a facility without being directly employed there are not off the hook. The facility must still make the training available to them, and the physician is expected to complete it.¹ Providers who work at more than one facility don’t have to sit through the same course repeatedly. A facility must issue a certificate of completion on request, and another covered facility can accept that certificate in place of running the provider through its own program.³

What the Training Must Cover

Health and Safety Code Section 123630.3 does not leave curriculum design open-ended. The law calls for an “evidence-based implicit bias program” and lists the components every course must address.³ A compliant program covers:

Identification of personal biases and misinformation that a provider may hold without recognizing it.
Personal, institutional, structural, and cultural barriers to inclusion.
Corrective measures to decrease bias at the interpersonal and institutional levels, including ongoing policies.
The effects of historical and contemporary exclusion and oppression of minority communities.
Cultural identity across racial and ethnic groups.
Effective communication across racial, ethnic, religious, and gender identities.
Power dynamics and organizational decision-making in patient care.
How implicit bias contributes to health inequities in perinatal care.
Perspectives from diverse local groups and experts on racial, cultural, and provider-community issues.
Education on the framework of reproductive justice.

AB 2319, the 2024 amendment, added an eleventh element: recognition of intersecting identities and the biases associated with them.⁴ The specificity is intentional. Every item on the list is something an auditor or the Attorney General’s office can ask a facility to demonstrate.

Training Deadlines and Refresher Cycle

SB 464 as originally passed did not set hard dates. AB 2319 filled that gap. Providers who were already working in covered facilities had to finish their initial implicit bias training by June 1, 2025. Any provider hired after that date must complete the program within six months of their start date.⁴

After the initial course, every covered provider must take a refresher at least once every two years. A facility can require refreshers on a shorter cycle if it decides more frequent training is needed to keep pace with best practices.³

Proof of Compliance and the Attorney General’s Role

The most significant change AB 2319 made was giving the training mandate real enforcement. Starting February 1, 2026, every covered facility must submit proof of compliance directly to the Attorney General’s office.⁴ The AG distributes a secure online survey to designated contacts at each facility.

Multi-hospital systems cannot roll up their reporting. Each facility must submit its own compliance data individually, even if it shares ownership, branding, or training vendors with sister hospitals.⁴ The Attorney General may publish a biennial report with the compliance data on the office’s website.⁵

The Attorney General has already treated this as an enforcement priority. Before AB 2319 took effect, the office ran an investigation into whether pregnancy-care providers were complying with SB 464’s anti-bias training requirement, signaling that the training mandate is not a paper exercise.⁶

Related Duty: Patient Rights Notice at Admission

Training is not the whole obligation SB 464 places on covered hospitals. The same law amended Health and Safety Code Section 1262.6 to require hospitals to give every patient, in writing at admission or as soon as reasonably possible afterward, a notice of the right to be free from discrimination based on race, color, religion, ancestry, national origin, disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, sexual orientation, citizenship, primary language, or immigration status.⁷

The notice must also tell patients how to file a complaint with three specific agencies:

The State Department of Public Health
The Civil Rights Department (formerly the Department of Fair Employment and Housing)
The Medical Board of California

A facility that has trained its perinatal staff but has not updated its admission paperwork is not fully compliant with the Dignity in Pregnancy and Childbirth Act.⁷

Key Dates at a Glance

October 2019: SB 464 signed, establishing the Dignity in Pregnancy and Childbirth Act.⁸
September 2024: AB 2319 signed, adding deadlines, the intersecting-identities training element, and Attorney General reporting.⁴
June 1, 2025: Initial training deadline for providers already working in covered facilities.⁴
February 1, 2026: First facility compliance report due to the Attorney General.⁴
Ongoing: New hires trained within six months; refreshers at least every two years.

1
California Legislative Information. California Health and Safety Code 123630.3
2
California Legislative Information. California Health and Safety Code 123630.2
3
California Legislative Information. California SB 464 – 2019-2020 Regular Session
4
State of California – Department of Justice – Office of the Attorney General. California Dignity in Pregnancy and Childbirth Act (AB 2319)
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California Legislative Information. California Health and Safety Code 123630.6
6
State of California – Department of Justice – Office of the Attorney General. Attorney General Bonta Announces Results of Investigation into Anti-Bias Training for Pregnancy Care Providers
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California Legislative Information. California Health and Safety Code 1262.6
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LegiScan. CA SB464 – 2019-2020 Regular Session