SB 1049 California Senate · 2025-2026 Regular Session

Health care claims reimbursement.

Summary

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer to reimburse a complete claim or a portion thereof within 30 calendar days after receipt of the claim, or, if a claim or portion thereof does not meet the criteria for completeness, to notify the claimant no later than 30 calendar days after receipt that the claim or portion thereof is contested or denied. This bill would grant a claimant no less than 90 calendar days to submit a corrected claim after a health care service plan or health insurer denies a claim or portion thereof or sends a notice of overpayment for a claim based on a defect that may be remedied by submitting a corrected claim. The bill would prohibit a plan or insurer from denying a corrected claim on the grounds that the claim was not submitted within another applicable claim filing deadline. Under the bill, a dispute related to a corrected claim would be required to be eligible for submission to the plan's or insurer's fast, fair, and cost-effective dispute resolution mechanism. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.

Issues: ✓ Healthcare

Bill status passed both 4 of 5 stages cleared

Introduction

Feb 2026

Committee Review

Jun 2026

Senate Passage

May 2026

Assembly Passage

Aug 2026

Governor

Introduced Feb 12, 2026 Last action Aug 28, 2026

Maddy AI version diff · 4 comparisons

What changed between versions

08/25/26 - Enrolled → SB1049 · 1 edit

MINOR

No substantive policy changes occurred between these two versions. The diff reflects a change in document format only: the 'from' version is the formal enrolled bill with official legislative headers, signature lines, and chapter numbering, while the 'to' version is a web page rendering of the same bill text from a legislative website, complete with navigation menus, status metadata, and publication date. The actual statutory language (Sections 1, 2, and 3) is identical in both versions.

TECHNICAL

The document changed from a formal enrolled bill format (with Senate/Assembly passage lines, Governor receipt line, chapter heading, and approval signature block) to a web page display format (with site navigation, bill status history, version list, and publication timestamp). No statutory text was altered.

04/06/26 - Amended Senate → 08/13/26 - Amended Assembly · 6 edits · Aug 13, 2026

MODERATE

The Assembly amendment broadens SB 1049 in several ways: it extends coverage to partial claim denials, changes the correction window from a fixed 90 days to a minimum of 90 calendar days, requires that disputes over corrected claims be eligible for fast dispute resolution mechanisms, and grants regulatory authority to state agencies to issue guidance without full Administrative Procedure Act rulemaking. These changes make the bill more protective of providers and give regulators more flexibility in implementation.

SCOPE

The bill now applies when a plan or insurer denies 'a claim or portion thereof' rather than only a whole claim, extending protection to partial denials.

REQUIREMENT

The time window for submitting a corrected claim changed from a fixed 90 days to 'no less than 90 calendar days,' making it a minimum floor and specifying calendar days instead of an ambiguous day count.

ENFORCEMENT

A new requirement that disputes related to corrected claims submitted under this section must be eligible for submission to the plan's or insurer's fast, fair, and cost-effective dispute resolution mechanism.

TECHNICAL

New subdivision (c) in both the Health and Safety Code and Insurance Code sections grants the department authority to issue guidance and regulations relating to the new provisions, exempt from Administrative Procedure Act rulemaking requirements. The Health and Safety Code version additionally allows the State Department of Health Care Services to issue consistent guidance.

Clarified language in subdivision (b) regarding the filing deadline exception, changing 'the provider did not submit the claim within an applicable claim filing deadline' to 'the provider did not submit the claim was not submitted within an applicable claim filing deadline other than the deadline specified in subdivision (a).'

Various formatting and alignment changes to headings, spacing, and page numbers with no substantive policy effect.

Floor votes · Senate May 19, 2026 · Assembly Aug 20, 2026

How they voted

32–2

Passed · 6 other

Total votes 40

May 19, 2026

D Democratic30

30 Yea

100% Yea

R Republican10

2 Yea 2 Nay 6

20% Nay

Vote distribution

All Yea All Nay Mixed No data

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Amendments

Aug 24, 2026

Upper · Passed

Assembly amendments concurred in. (Ayes 31. Noes 6.) Ordered to engrossing and enrolling.

upper

Aug 20, 2026

Introduced

In Senate. Concurrence in Assembly amendments pending.

upper

Aug 20, 2026

Lower · Passed

Read third time. Passed. Ordered to the Senate.

lower

Aug 13, 2026

Lower · Passed

Read second time and amended. Ordered to second reading.

lower

Aug 13, 2026

Lower · Passed

From committee: Do pass as amended. (Ayes 11. Noes 0.) (August 13).

lower

Jun 24, 2026

Lower · Passed

From committee: Do pass and re-refer to Com. on APPR. (Ayes 15. Noes 0.) (June 23). Re-referred to Com. on APPR.

lower

May 26, 2026

Committee

Referred to Com. on HEALTH.

lower

May 19, 2026

Upper · Passed

Read third time. Passed. (Ayes 32. Noes 2. Page 4342.) Ordered to the Assembly.

upper

May 14, 2026

Upper · Passed

From committee: Do pass. (Ayes 5. Noes 2. Page 4262.) (May 14).

upper

Apr 6, 2026

Upper · Passed

Read second time and amended. Re-referred to Com. on APPR.

upper

Mar 26, 2026

Upper · Passed

From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 8. Noes 1. Page 3690.) (March 25).

upper

Feb 26, 2026

Committee

Referred to Com. on HEALTH.

upper

Feb 12, 2026

Introduced

Introduced. Read first time. To Com. on RLS. for assignment. To print.

upper

1 primary · 1 co-sponsor