Health care coverage reporting.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Vetoed
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Overview
This bill requires health care service plans and health insurers in California to publicly report data on their prior authorization processes and claims payments. Specifically, it mandates the reporting of details about prior authorization requests, denials, approval rates, and timelines, as well as data on claims adjudicated, denied, and contested, broken down by various demographic categories. The Department of Managed Health Care and the Insurance Commissioner will be responsible for posting this information on their websites, promoting transparency in the healthcare system.
Key provisions
- Health care service plans and health insurers must report prior authorization data on their websites.
- Data must include details on prior authorization requests, approvals, denials, and timelines.
- Annual reporting is required, starting in 2026 and 2028 respectively.
- Health insurers must also report claims payment and dispute resolution data.
- Data will be disaggregated by plan/insurer and demographic categories (age, gender, ethnicity, etc.).
- The Departments of Managed Health Care and Insurance are responsible for posting the data.
- The Commissioner can reject reports and assess administrative penalties for non-compliance.
- Rules and regulations will be established to govern the reporting requirements.
Who is affected
- Health care service plans
- Health insurers
- Patients
- Healthcare providers
Bill text
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