Bill > SB306

This bill aims to reform prior authorization processes for health care service plans and health insurers in California by requiring detailed reporting and potentially eliminating prior authorization for frequently approved health care services. Specifically, by July 1, 2026, health care plans and insurers must report statistics about their prior authorization processes to state departments, including the percentage of services approved or modified. The departments will then evaluate these reports and identify health care services approved at a rate of 90% or higher. By January 1, 2028, plans and insurers will be required to cease requiring prior authorization for these frequently approved services, though exceptions exist for certain types of services like experimental treatments, out-of-network care, and high-tier prescription drugs. The bill also allows plans and insurers to reinstate prior authorization for specific providers who engage in fraudulent activity or consistently provide clinically inappropriate care. Additionally, no later than four years after removing prior authorization requirements, the departments must publish a report analyzing the impacts of these changes. The bill includes provisions to ensure transparency, protect patient care, and reduce administrative barriers, and is set to expire on January 1, 2034.

Budget and Finance, Health and Social Services

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260SB306