CaliforniaHealth care coverage: prior authorization.
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 disability insurers by the Department of Insurance. Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including pursuant to contracts with various types of managed care plans.
More detail
Existing law generally authorizes a health care service plan, including a Medi-Cal managed care plan, or disability insurer to use utilization review, 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. For a request prior to or concurrent with the provision of health care services, existing law requires utilization review decisions to be made within 5 business days from the plan's or insurer's receipt of the information reasonably necessary and requested by the plan or insurer to make the determination, or within 72 hours if the enrollee or insured faces an imminent and serious threat to their health or the normal timeframe would be detrimental to their life or health, as specified.
This bill would change the timeline for prior or concurrent authorization requests to no more than 3 business days from the plan's or insurer's receipt via electronic submission, or 5 business days from receipt via submission that is not electronic, of the information reasonably necessary and requested by the plan or insurer to make the determination. The bill would require a utilization review decision to be made within 24 hours from receipt of a prior or concurrent authorization request via electronic submission, or 48 hours from receipt via submission that is not electronic, if the enrollee or insured faces an imminent and serious threat to their health or the normal timeframe would be detrimental to their life or health. Because a willful violation of this provision by a health care service plan would be a crime, the bill would impose a state-mandated local program. The bill would exclude Medi-Cal managed care plans from the above-described timeline changes.
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.
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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 512 Harabedian Concurrence in Senate Amendments. Result: pass.Lower
- Sep 10Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 67. Noes 2. Page 3219.).Major
- Sep 9In Assembly. Concurrence in Senate amendments pending.
- Vote recorded 3rd Reading AB512 Harabedian et al. By Becker. Result: pass.Upper
- Sep 9Read third time. Passed. Ordered to the Assembly. (Ayes 30. Noes 0. Page 2656.).Passed Senate
- Sep 8Read second time. Ordered to third reading.Minor
- Sep 5Read second time and amended. Ordered returned to second reading.Major
- 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 5. Noes 0.) (August 29).Minor
- Aug 18In committee: Referred to suspense file.Minor
- Vote recorded Placed on suspense file. Result: pass.Upper
- Jul 14Read second time and amended. Re-referred to Com. on APPR.Major
- Jul 10From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (July 9).Major
- Jul 9
- Vote recorded Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations]. Result: pass.Upper
- Jun 11Referred to Com. on HEALTH.Minor
- Jun 3In Senate. Read first time. To Com. on RLS. for assignment.Minor
- Jun 2Read third time. Passed. Ordered to the Senate. (Ayes 68. Noes 1. Page 1834.)Passed Assembly
- Vote recorded AB 512 Harabedian Assembly Third Reading. Result: pass.Lower
- May 27Read second time. Ordered to third reading.Minor
- May 23From committee: Do pass. (Ayes 12. Noes 0.) (May 23).Minor
- Vote recorded Do pass. Result: pass.Lower
- May 14In committee: Set, first hearing. Referred to suspense file.Minor
- Apr 29Re-referred to Com. on APPR.Minor
- Apr 28Read second time and amended.Major
- Apr 24From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 13. Noes 0.) (April 22).Major
- Apr 22
- Vote recorded Do pass as amended and be re-referred to the Committee on [Appropriations]. Result: pass.Lower
- Apr 21Re-referred to Com. on HEALTH.Minor
- Apr 11From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.Major
- Feb 24Referred to Com. on HEALTH.Minor
- Feb 11From printer. May be heard in committee March 13.
- Feb 10Read first time. To print.Introduced