Health Insurance

AB 280 (Aguiar-Curry, D-Davis)

Follow

Passed the Assembly on June 2. To be heard in the Senate Health Committee.

AB 280 would require a plan or insurer to annually verify and delete inaccurate listings from its provider directories and would require a provider directory to be 60% accurate on July 1, 2026, with increasing percentage accuracy benchmarks required to be met each year until the directories are 95% accurate by July 1, 2029. The bill would subject a plan or insurer to administrative penalties for failure to meet the prescribed benchmarks. The bill would require a plan or insurer to provide coverage for all covered health care services provided to an enrollee or insured who reasonably relied on inaccurate, incomplete, or misleading information contained in a provider directory and to reimburse the provider the out-of-network amount for those services. Amendments taken in the Assembly Appropriations Committee exempt Medi-Cal managed care plans from the accuracy percentage requirements and administrative penalties.

AB 371 (Haney, D-San Francisco)

Support

Held on the Assembly Appropriations Committee suspense file on May 23.

AB 371 would implement additional network adequacy standards — including time and distance standards and requirements — for specified plans and insurers that cover dental services. The plans and insurers would  be required to offer dental appointments subject to the regulatory geographic accessibility standards of the Department of Managed Health Care (DMHC) or the Department of Insurance (DOI). The bill would also require that DMHC or DOI review an entire dental provider network’s adequacy. 

Assembly Health Committee Support Letter

Assembly Appropriations Committee Support Letter

AB 384 (Connolly, D-San Rafael)

Support

Held on the Assembly Appropriations Committee suspense file on May 23.

AB 384 would prohibit health care service plans, including Medi-Cal managed care plans, from requiring prior authorization for mental health and substance use disorder patients.

Assembly Health Committee Support Letter

Assembly Appropriations Committee Support Letter

AB 510 (Addis, D-San Luis Obispo)

Support

Held on the Assembly Appropriations Committee suspense file on May 23.

AB 510 would establish a peer-to-peer review process that would authorize a provider to request review of a health care service plan’s or insurer’s decision that delays, denies, or modifies health care service based on medical necessity. The bill would provide that a peer physician — or, in specified circumstances, other peer-licensed health care professional — conduct the review. The bill would also require that reviews occur within two business days of the request or more timely as needed based on the enrollee’s condition. Additionally, if the plan fails to meet the review timelines, the service shall be deemed approved, superseding any prior delay, denial, or modification.   

Assembly Health Committee Support Letter

Assembly Appropriations Committee Support Letter

AB 512 (Harabedian, D-Pasadena)

Support

Passed the Assembly on June 2. To be heard in the Senate Health Committee.

AB 512 would shorten the timeline for prior authorization and concurrent review requests — from within five business days to no more than 48 hours for standard requests or from 72 hours to 24 hours for urgent requests — from when the plan or insurer received the reasonably necessary information it requests to make the determination.

Assembly Health Committee Support Letter

Assembly Appropriations Committee Support Letter

Assembly Floor Alert in Support

AB 539 (Schiavo, D-Santa Clarita)

Support

Passed the Assembly on May 12. June 18 hearing in the Senate Health Committee.

AB 539 would require that a health care service plan’s or health insurer’s prior authorization for a health care service remain valid for a period of at least one year from the date of approval, or throughout the course of prescribed treatment if less than one year.

Senate Health Committee Support Letter

AB 669 (Haney, D-San Francisco)

Support

Passed the Assembly on June 3. Pending a Senate policy committee assignment.

AB 669 would require health plans, starting in 2027, to cover medically necessary prescription drugs; outpatient services; and the first 28 days of inpatient, intensive outpatient, or partial hospitalization treatment for substance use disorders without prior authorization. The bill specifies a concurrent review with an appeal process for in-network inpatient substance use treatment that lasts longer than 28 days.

Assembly Health Committee Support Letter

Assembly Appropriations Committee Support Letter

Assembly Floor Alert in Support

AB 682 (Ortega, D-Hayward)

Support

Passed the Assembly on May 27. To be heard in the Senate Health Committee.

AB 682 would mandate that health plans collect and publicly report health insurance claims denial information. The information collected and reported would include the number of claims processed, adjudicated, denied, or partially denied.

Senate Health Committee Support Letter

SB 32 (Weber Pierson, D-San Diego)

Support

Passed the Senate on June 2. To be heard in the Assembly Health Committee.

SB 32 would require the Department of Health Care Services, Department of Managed Health Care, and Department of Insurance to develop and adopt, by July 1, 2027, time or distance accessibility standards for hospitals with perinatal units, which health plans would be required to meet. The bill would require that the perinatal unit time or distance standards not be longer than Medi-Cal managed care plans. SB 32 would also require that the departments consult with stakeholders in developing the standards, and it would allow for alternative access standards. These provisions would become inoperative on July 1, 2033, and be repealed on Jan. 1, 2034.

Senate Health Committee Support Letter

Senate Appropriations Committee Support Letter

Senate Floor Alert in Support

SB 306 (Becker, D-Menlo Park)

Support

Passed the Senate on May 28. To be heard in the Assembly Health Committee.

SB 306 would prohibit a health care plan, health insurer, or an entity with which the plan or insurer contracts for prior authorization from imposing prior authorizations on a covered health care service for certain conditions for one year — including if, in the prior year, the plan approved 90% or more of the same requests for a covered service.

Assembly Health Committee Support Letter

SB 363 (Wiener, D-San Francisco)

Support

To be heard in the Assembly Health Committee.

SB 363 would require health plans and insurers to annually report to either the Department of Managed Health Care or the Department of Insurance their total number of claims processed, as well as treatment denials or modifications. If more than 50% of independent medical reviews result in the overturning or reversal of treatment denial or modification, health plans and insurers would be liable for administrative penalties.