Bill > AB682

This bill requires health care service plans and health insurers in California to provide more transparency about their prior authorization and claims processes. Starting in 2026 for health care service plans and 2028 for health insurers, these organizations must publicly report detailed data on their websites about prior authorization requests, including the percentages of requests approved, denied, or appealed, as well as the average processing times. Additionally, they must submit annual reports to their respective regulatory departments (the Department of Managed Health Care and the Department of Insurance) detailing claims data, such as the number of claims processed, denied, or contested, broken down by various categories like provider type, reason for denial, and eventually by demographic information. The departments will then post this information on their websites by April 15th each year, ensuring public access while protecting individual patient privacy. The bill gives the directors of these departments the authority to establish reporting guidelines, reject incomplete reports, and assess penalties for non-compliance. By mandating these reporting requirements, the bill aims to increase transparency and help consumers and policymakers better understand how health care coverage decisions are made.

Budget and Finance, Health and Social Services

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260AB682