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 generally authorizes a health care service plan or health insurer to use prior authorization and other utilization review or utilization management functions, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law requires a health care service plan or health insurer, including those plans or insurers that delegate utilization review or utilization management functions to medical groups, independent practice associations, or to other contracting providers, to comply with specified requirements and limitations on their utilization review or utilization management functions. Existing law requires the criteria or guidelines used to determine whether or not to authorize, modify, or deny health care services to be developed with involvement from actively practicing health care providers. This bill would require the Department of Managed Health Care and the Department of Insurance, by July 1, 2025, to issue instructions to health care service plans and health insurers to report specified information relating to prior authorization, as defined, including designated health care services (services) , items, and supplies subject to prior authorization and the percentage rate at which health care service plans, health insurers, or their delegated entities, approve or modify those services, items, and supplies. The bill would require health care service plans and health insurers to report that information to the relevant department by December 31, 2025, or as otherwise specified. The bill would require the relevant department to evaluate the reports received from the health care service plans and health insurers, and identify the services, items, and supplies most frequently approved by the plans or insurers or their delegated entities, as specified. The bill would require each department, after evaluating the reports received from health care service plans and health insurers, to identify, and by December 31, 2026, to publish a list of, the most frequently approved or modified services, items, and supplies, based on a prescribed threshold percentage rate. The bill would authorize the department to consider certain factors when determining the appropriateness of removing prior authorization for a specific health care service, item, or supply, regardless of its approval percentage rate. The bill would require the department to issue instructions to health care service plans and health insurers regarding, among other matters, the date by which the listed services, items, and supplies would no longer be subject to prior authorization, and how a plan or insurer could reinstate prior authorization upon a showing of good cause, as prescribed. Within 4 years from the cessation date of the prior authorization requirements, the bill would require each department to publish a report regarding the impact of the cessation of those requirements. The bill would authorize the departments to contract with a consultant with expertise in prior authorization procedures to assist with implementation of the bill, as specified. The bill would provide that it would not apply with respect to specified types of health care service plans including, but not limited to, specialized health care service plans, or to specialized health insurers, except as specified. The provisions would be repealed on January 1, 2032. Because a willful violation of the bill's requirements relative to health care service plans 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.
Asm. Corey Jackson
Sponsored bills
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. This bill would require a health care service plan, except as specified, or health insurer to provide to enrollees and insureds a written or electronic notice regarding the benefits of a behavioral health and wellness screening, as defined, for children and adolescents 8 to 18 years of age. The bill would require a health care service plan or insurer to provide the notice annually. Because a violation of the bill's requirements relative to a health care service plan would be crimes, 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.
This measure would designate the month of October 2024 as California Hindu American Awareness and Appreciation Month. The measure would also recognize and acknowledge the significant contributions made by Californians of Hindu heritage to the state and seek to increase awareness and understanding of the Hindu American community, and would condemn all hate crimes and bias incidents against Hindu Americans, Hindu temples and centers, and places of significance to the Hindu American community.
This measure would request the Congress of the United States to pass, and the President to sign, the Housing Crisis Response Act of 2023 (H.R. 4233) , the Ending Homelessness Act of 2023 (H.R. 4232) , and the Downpayment Toward Equity Act of 2023 (H.R. 4231) .
Maddy summaryAssembly Concurrent Resolution 217 designates June 29, 2024, as Play Day to encourage all Californians to participate in physical activities. The resolution highlights the importance of play for youth development and addresses disparities in access to sports based on income and race. It serves as a commemorative measure rather than a law that creates new regulations or funding.
Maddy summaryThis bill officially designates October 2024 as California Firefighter Appreciation Month and October 12, 2024, as California Firefighters Memorial Day. The legislation aims to honor the over 1,500 firefighters whose names are engraved on the California Firefighters Memorial at the State Capitol and to recognize the roughly three million emergency incidents firefighters handle annually. It encourages all Californians to express gratitude to active firefighters and to remember those who have died in the line of duty or from work-related illnesses. The resolution also notes that a formal ceremony will be held on October 12 in Sacramento to commemorate these sacrifices.
Maddy summaryThis bill designates September 2024 as Blood Cancer Awareness Month in California to highlight the symptoms, causes, and treatment advances for blood and lymphatic cancers. It aims to educate the public about conditions such as leukemia, lymphoma, and multiple myeloma by encouraging recognition of warning signs like fatigue and swollen lymph nodes. The resolution does not create new laws or funding but serves to promote community dialogue and support for patients and their families.
Maddy summaryThis California House Resolution commemorates the history and contributions of Pakistani Americans in the state. It recognizes Pakistan's independence, the nation's role in promoting global liberty, and the achievements of Pakistani immigrants in fields such as technology, medicine, and public service. The resolution urges all Californians to celebrate the friendly relations between the United States and Pakistan while honoring the cultural heritage of the Pakistani-American community.
Maddy summaryThis bill designates October as California Promotoras Month to honor the work of community health workers who bridge gaps between underserved populations and the healthcare system. Promotoras, who are often women-led and serve as trusted cultural brokers, provide education and support in areas like maternal health and chronic disease management within their communities. The resolution formally acknowledges their essential role in addressing health inequities and recognizes the leadership of the organizations that employ or support them. By declaring this specific month, the Assembly aims to raise public awareness about the contributions of these workers without changing any laws or funding.
Maddy summaryThis bill officially designates September 2024 as Childhood Cancer Awareness Month in California to raise public awareness about the disease. It acknowledges the significant impact of childhood cancer on patients and their families while highlighting the state's commitment to supporting research and prevention efforts. The resolution also recognizes the vital work of organizations like the American Cancer Fund for Children and Lions Clubs International in providing support services. By declaring this month, the Assembly aims to encourage governmental officials and the public to learn more about the challenges and needs associated with childhood cancer.