AB 236 (Holden, D-Pasadena)
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Held on the Senate Appropriations Committee suspense file on Aug. 15.
AB 236 would have required a health plan or insurer to annually audit and delete inaccurate listings from its provider directories, including deleting a provider from its directory if the plan or insurer has not financially compensated a provider in the prior year. It would have also required the Department of Managed Health Care and the Department of Insurance to develop uniform formats for plans and insurers to use to request directory information from providers, and it would have authorized the departments to establish methodology and processes to ensure accuracy of provider directories.
AB 1842 (Reyes, D-San Bernardino)
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Signed by the governor on Sept. 27.
AB 1842 requires a group or individual health care service plan or health insurer offering an outpatient prescription drug benefit to provide coverage without prior authorization, step therapy, or utilization review for at least one medication approved by the United States Food and Drug Administration in each of four designated categories, including medication for the reversal of opioid overdose, such as a naloxone product or another opioid antagonist.
AB 3059 (Weber, D-La Mesa)
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Signed by the governor on Sept. 29.
AB 3059 clarifies that donor milk is covered as part of essential health benefits for babies who have a medical necessity. The bill exempts hospitals from having a tissue bank license in order to distribute donor milk to babies in the neonatal intensive care unit.
AB 3221 (Pellerin, D-Santa Cruz)
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Signed by the governor on Sept. 27.
AB 3221 requires records, books, and other documentation from health plans to be available for inspection, including in electronic form, by the Department of Managed Health Care.
AB 3260 (Pellerin, D-Santa Cruz)
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Held on the Senate Appropriations Committee suspense file on Aug. 15.
AB 3260 would have required health plans to expedite reviews of urgent grievances and make determinations of urgency by enrollees’ health care providers binding.
AB 3275 (Soria, D-Merced and R. Rivas, D-Salinas)
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Signed by the governor on Sept. 27.
AB 3275 updates and clarifies requirements for health care service plans or health insurers to timely reimburse services provided by hospitals.
SB 294 (Wiener, D-San Francisco)
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Held on the Assembly Appropriations Committee suspense file on Aug. 15.
SB 294 would have required a health care service plan or disability insurer that provides coverage for mental health or substance use disorders (SUDs) to treat as a grievance any modification, delay, or denial issued in response to an authorization request for coverage of treatment for a mental health or SUD for an insured up to 26 years of age.
SB 516 (Skinner, D-Oakland)
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Re-referred to the Assembly Health Committee on Aug. 22. Aug. 27 hearing in the Assembly Health Committee canceled at the author’s request.
SB 516 would have required health plans and insurers to report data regarding prior authorization (PA) and approval rates and would have required the Department of Managed Health Care and the Department of Insurance to assess this information and provide direction regarding elimination of PA for certain procedures.
SB 999 (Cortese, D-Campbell)
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Held on the Assembly Appropriations Committee suspense file on Aug. 15.
SB 999 would have imposed certain requirements on health plans and insurers, including:
- Having qualified health care providers in the relevant clinical specialty review appeals and make initial review determinations
- Maintaining telephone and other direct communication access during normal business hours for health care providers to request authorization for mental health and substance use disorder care
- Providing health care providers and enrollees the clinical citations used for denials of care
SB 1120 (Becker, D-Menlo Park)
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Signed by the governor on Sept. 28.
SB 1120 addresses a health plan’s use of artificial intelligence, algorithm, or other software decision-making tools to inform authorization or coverage decisions, including specified requirements for oversight, disclosure, and fair and equitable application.
SB 1180 (Ashby, D-Sacramento)
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Signed by the governor on Sept. 28.
SB 1180 requires a health care service plan contract issued, amended, or renewed on or after July 1, 2025, to establish a reimbursement process for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program. The bill also requires coverage of these programs under Medi-Cal, upon appropriation and receipt of any necessary federal approvals and the availability of federal financial participation.
SB 1320 (Wahab, D-Fremont)
Support
Signed by the governor on July 15.
SB 1320 requires health plans and insurers to create a process to reimburse providers for mental health and substance use disorder treatment services that are integrated with primary care services.