Health care coverage: claims payments.

In Section 1 (H&S Code 1371.30), subsection (7)(A): The file size limit requirement is now incorporated into the definition of 'standard electronic submission method' by adding 'including establishing a file size limit sufficient to allow submission of typical medical documentation required to adjudicate claims' directly after 'method.' Previously this was stated as a separate sentence.

In Section 2 (H&S Code 1371.35), subsection (f)(1): The phrase 'A plan shall maintain reasonable minimum technical standards, including a file size limit sufficient to allow submission of typical medical documentation required to adjudicate claims' was replaced with 'including establishing a file size limit sufficient to allow submission of typical medical documentation required to adjudicate claims' as part of the methods description. This removes the broader 'reasonable minimum technical standards' language and narrows the obligation to specifically the file size limit.

In the bill summary paragraph, the phrase 'as defined' was changed to 'as defined, specified' when describing the standard electronic submission method, and a typo ('would would') was corrected to 'would.'

Page numbering shifted from 94 to 93 throughout the document, reflecting a one-page reduction in length due to the text consolidation.

A commencement date of May 26, 2028 was added to the electronic submission requirements in both Section 1371(7)(A) and Section 1371.35(f)(1). Previously these provisions had no specified effective date, meaning they would have taken effect immediately upon the bill's enactment.

A new exception was added stating that the electronic submission requirements do not apply during periods when a plan's ability to accept electronic records is impacted by circumstances outside its reasonable control, including power outages, natural disasters, cybersecurity attacks, or similar incidents. This appears in both Section 1371(7)(B) and Section 1371.35(f)(2).

In Section 1371(7)(A), the requirement that plans 'maintain reasonable minimum technical standards, including a file size limit sufficient to allow submission of typical medical documentation' was removed and replaced with a new provision (paragraph C) stating that if a state or federal standard is adopted specific to file size, number, or other capacity requirements for claims-related supporting documentation submissions, that standard shall apply. The original technical standards language remains in Section 1371.35(f)(1).

New clarifying language was added stating that the electronic submission provisions do not prohibit a plan from denying, pending, or delaying a claim to the extent authorized under law. This appears in both sections and serves as a savings clause.

The entire corrections component (Adrienne's Act) was removed. This had required Cal/OSHA to submit a rulemaking proposal by July 1, 2027 for occupational safety standards specifically applicable to workers in prisons and institutions under the Department of Corrections and Rehabilitation.

The operative date of January 1, 2026 was removed from Section 1371 (Health and Safety Code), meaning its claims payment requirements will now take effect on the standard July 1, 2026 date instead of retroactively.

The operative date of January 1, 2026 was removed from Section 1371.35 (Health and Safety Code), meaning its emergency claims payment requirements will now take effect on the standard July 1, 2026 date instead of retroactively.

Coauthors Assembly Members Schultz and Sharp-Collins were removed from the bill attribution.

The entire Climate Justice in Prisons Emergency Response Act (Penal Code Chapter 19, Sections 7470 and following) is deleted. This removed requirements for CDCR to install shade structures, cooling systems, temperature monitoring sensors, a Temperature Monitoring and Data Transparency Pilot Program in three prisons, a working group with community organizations, annual training on heat illness, air quality monitoring protocols during wildfires, and a phased infrastructure improvement plan due by January 2028.

All legislative findings and declarations about climate change, its disproportionate impact on incarcerated people, structural racism in incarceration rates, and the intent to use prison closure as a compliance strategy are removed.

The bill's stated purpose changes from 'relating to corrections' (covering both Labor Code and Penal Code) to covering the Labor Code for corrections AND amending Health and Safety Code Sections 1371 and 1371.35 plus Insurance Code Sections 10123.13 and 10123.147 relating to health care coverage.

Health care service plans must now reimburse complete claims within 30 calendar days of receipt or pay interest at 15 percent per annum. Plans must automatically include accrued interest in payments without requiring a request from the claimant, and face an additional fee of the greater of $15 or 10 percent of accrued interest for failing to do so.

Plans must accept electronic medical records and supporting documentation through standard electronic submission methods (designated portal or per Section 130290 and federal interoperability rules). Plans are prohibited from denying, pending, or delaying a claim solely because their systems cannot accept documentation that otherwise meets stated requirements.

New definition of 'electronic submission' is added, meaning submission through an electronic portal designated by the plan or in accordance with Section 130290 and applicable federal interoperability rules.

Specialized health care service plans that arrange solely for vision care services may use statistically reliable methods to recover overpayments from suspected fraud, but only if they comply with detailed notice requirements including description of methodology, sample size justification per AICPA guidance, claim-level detail, and a 45-working-day dispute window for providers.

Providers may dispute a specialized plan's fraud findings within 45 working days. Plans may offset overpayments against current claim submissions only if the provider fails to reimburse within 45 working days, the plan gives at least 10 working days written notice identifying specific claims to withhold, and withheld amounts do not exceed the asserted debt.

The Department of Managed Health Care may issue compliance guidance and amend regulations for consistency with the new provisions without being subject to Administrative Procedure Act rulemaking requirements until December 31, 2027. The health care service plan provisions become operative January 1, 2026.

A sentence was added to the bill summary: 'Because a violation of the standard would be a crime, this bill would impose a state-mandated local program.' This clarifies that criminal penalties for violations trigger state-mandated local program reimbursement obligations under the California Constitution.

In Section 6720.1(b)(1) of the Labor Code, the word 'adopted' was inserted after 'Penal Code and,' so the text now reads 'consistent with the requirements described in Chapter 19... of the Penal Code and, adopted, as appropriate, may draw from...' This appears to clarify that consistency is required with the chapter as adopted.

In Section 6720.1(b), the introductory phrase appears to have changed from 'all of the following' to 'both of the following' (rendered as 'all both' in the diff), which may be a drafting error since three numbered items follow.

Subsection lettering in the legislative findings (Section 2) was reorganized with blank lines inserted at positions (g) and (h), shifting subsequent subsection labels. The content of each finding is unchanged.

A new Section 1 was added naming the act 'Adrienne's Act,' giving it a public short title for citation purposes.

All existing sections were renumbered up by one to accommodate the new Section 1: findings moved from SEC. 1 to SEC. 2, the Labor Code section (6720.1) moved from SEC. 2 to SEC. 3, and the Penal Code chapter (Chapter 19, Sections 7470-7471) moved from SEC. 3 to SEC. 4.