Bill > SB306

This bill aims to reduce prior authorization requirements for health care service plans and health insurers by implementing a performance-based exemption system. Specifically, if a health care service plan or health insurer approves 90% or more of requests for a specific covered health care service in the prior calendar year, they must waive prior authorization requirements for that service for one year, starting April 1st of the current year. The bill requires these plans and insurers to publicly list on their websites, by March 15th each year, the covered health care services subject to prior authorization and their approval rates for each service. "Prior authorization" is defined as a process where utilization review determines the medical necessity or appropriateness of health care services before or during their delivery, including requirements for pre-approval from the health plan. The bill applies only to in-network contracted providers and provides clear guidelines for calculating approval rates by dividing approved requests by total prior authorization decisions for each service. By reducing administrative barriers, the legislation seeks to streamline healthcare access and reduce bureaucratic delays in medical service delivery. The bill also includes a provision that ensures no additional state reimbursement is required for implementing these changes.

Budget and Finance, Health and Social Services

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