Bill > AB669

This bill aims to improve coverage for substance use disorder treatments by establishing new regulations for health care service plans and health insurers starting January 1, 2027. Specifically, the bill prohibits concurrent or retrospective medical necessity reviews for the first 28 days of inpatient, residential, intensive outpatient, or partial hospitalization substance use disorder treatment. During this initial period, health plans can only use prior authorization, and the treatment plan can include any number of days or levels of care as determined medically necessary. After 28 days, concurrent or retrospective reviews may be allowed, but with specific restrictions, such as review intervals no more frequent than every two weeks. The bill also requires expedited internal and external appeal processes if a plan denies continued treatment, ensures patients cannot be discharged during appeals, and mandates that facilities provide discharge plans. Additionally, the bill prohibits prior authorization for outpatient prescription drugs to treat substance use disorders when deemed medically necessary by a prescribing physician. The new regulations do not apply to Medi-Cal behavioral health delivery systems or managed care plans. The bill is designed to reduce barriers to accessing substance use disorder treatment and ensure more consistent, patient-centered care.

Budget and Finance, Health and Social Services

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260AB669