CaliforniaHealth care coverage reporting.
What it does
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use prior authorization and other utilization review or utilization management functions, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity.
More detail
Existing law requires a health care service plan or health insurer to file various reports with the relevant regulating department.
This bill would require a health care service plan or health insurer that imposes prior authorization to report specified prior authorization data from the previous calendar year on its internet website on or before February 1, 2026, for health care service plans, on or before February 1, 2028, for health insurers, and annually on or before February 1 thereafter. The bill would require a health care service plan or health insurer to annually report specified claims and prior authorization data to the relevant department by February 1 of each year, beginning February 1, 2027, for health care service plans and February 1, 2028, for health insurers. The bill would require the departments to post this information, disaggregated by plan or insurer, on their internet websites by April 15 of each year, beginning April 15, 2027, for health care service plans and April 15, 2028, for health insurers. The bill would authorize the Director of the Department of Managed Health Care and the Insurance Commissioner to reject a report required pursuant to these provisions, and would authorize the commissioner to assess an administrative penalty against a health insurer for a failure to correct a deficiency in the report. The bill would authorize the director and commissioner to make rules and regulations specifying the form and content of the reports posted online and submitted to the relevant department, as specified. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Where do you stand?
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Where it stands
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Jan 22Consideration of Governor's veto stricken from file.Latest
- 2025
- Oct 6Consideration of Governor's veto pending.
- Oct 6Vetoed by Governor Gavin Newsom.Major
- Sep 22Enrolled and presented to the Governor at 3 p.m.To Governor
- Sep 11
- Vote recorded AB 682 Ortega Concurrence in Senate Amendments. Result: pass.Lower
- Sep 10Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 66. Noes 3. Page 3225.).Major
- Sep 9In Assembly. Concurrence in Senate amendments pending.
- Vote recorded 3rd Reading AB682 Ortega et al. By Cortese. Result: pass.Upper
- Sep 9Read third time. Passed. Ordered to the Assembly. (Ayes 31. Noes 3. Page 2665.).Passed Senate
- Sep 8Read second time. Ordered to third reading.Minor
- Sep 4Read third time and amended. Ordered to second reading.Major
- Aug 29Read second time. Ordered to third reading.Minor
- Vote recorded Do pass. Result: pass.Upper
- Aug 29From committee: Do pass. (Ayes 6. Noes 0.) (August 29).Minor
- Aug 18In committee: Referred to suspense file.Minor
- Vote recorded Placed on suspense file. Result: pass.Upper
- Jul 17Read second time and amended. Re-referred to Com. on APPR.Major
- Jul 17From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (July 16).Major
- Jul 16
- Vote recorded Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations]. Result: pass.Upper
- Jun 23From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.Major
- Jun 4Referred to Com. on HEALTH.Minor
- May 28In Senate. Read first time. To Com. on RLS. for assignment.Minor
- May 27Read third time. Passed. Ordered to the Senate. (Ayes 76. Noes 0. Page 1739.)Passed Assembly
- Vote recorded AB 682 Ortega Consent Calendar Second Day. Result: pass.Lower
- May 22Read second time. Ordered to Consent Calendar.Minor
- May 21From committee: Do pass. To Consent Calendar. (Ayes 15. Noes 0.) (May 21).Minor
- Vote recorded Do pass. To Consent Calendar. Result: pass.Lower
- May 14In committee: Hearing postponed by committee.
- Apr 30From committee: Do pass and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 16. Noes 0.) (April 29). Re-referred to Com. on APPR.Minor
- Apr 29
- Vote recorded Do pass and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar. Result: pass.Lower
- Mar 3Referred to Com. on HEALTH.Minor
- Feb 15From printer. May be heard in committee March 17.
- Feb 14Read first time. To print.Introduced