Health care: medically necessary treatment.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Health
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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 aims to improve access to medically necessary treatment for Californians by strengthening the responsibilities of health care service plans and health insurers. Specifically, it requires these plans to cover physical conditions and diseases under the same terms as mental health and substance use disorders, ensures timely access to out-of-network care, and establishes clinical criteria for utilization review. It also creates penalties for non-compliance.
Key provisions
- Requires health care service plans and health insurers to cover medically necessary treatment for physical conditions and diseases under the same terms as mental health and substance use disorders.
- Requires the use of specified clinical criteria and guidelines in utilization review for physical conditions and diseases.
- Authorizes penalties for violations of utilization review requirements.
- Defines ‘medically necessary health care service’ as legally prescribed medical care that is reasonable and comports with medical community standards.
- Updates existing law to align with these new requirements.
- Addresses potential conflicts between coverage and public entitlement programs.
- Establishes a process for ensuring compliance with utilization review standards.
Who is affected
- Health care service plans
- Health insurers
- Policyholders
- Enrollees
Bill text
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Sponsors
Official sponsors from legislative records.
1 on record
Primary sponsor
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