Jared William Huffman
- Democratic
Author
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the 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. Commonly referred to as utilization review, existing law governs the procedures that apply to every health care service plan and health insurer that prospectively, retrospectively, or concurrently reviews and approves, modifies, delays, or denies, based on medical necessity, requests by providers prior to, retrospectively, or concurrent with, the provision of health care services to enrollees or insureds, as specified. Existing law also imposes various requirements and restrictions on health care service plans and health insurers, including, among other things, requiring a health care service plan that provides prescription drug benefits to maintain an expeditious process by which prescribing providers, as described, may obtain authorization for a medically necessary nonformulary prescription drug, according to certain procedures. Existing law also requires every health care service plan that provides prescription drug benefits that maintains one or more drug formularies to provide to members of the public, upon request, a copy of the most current list of prescription drugs on the formulary. This bill would impose specified requirements on health care service plans or health insurers that restrict medications for the treatment of pain pursuant to step therapy or fail first protocol. The bill would authorize the duration of any step therapy or fail first protocol to be determined by the prescribing participating plan provider or prescribing provider, as respectively defined, and would, except under certain conditions, prohibit a health care service plan or health insurer from requiring that a patient try and fail on more than 2 pain medications before allowing the patient access to other pain medication prescribed by the prescribing participating plan provider or prescribing provider, as specified. Because a willful violation of the bill's provisions 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.
Vetoed by Governor.
Consideration of Governor's veto pending.
Enrolled and presented to the Governor at 12:15 p.m.
Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 60. Noes 15. Page 6621.).
Assembly Rule 77 suspended. (Page 6605.)
Read third time. Passed. Ordered to the Assembly. (Ayes 23. Noes 11. Page 4975.).
In Assembly. Concurrence in Senate amendments pending. May be considered on or after August 31 pursuant to Assembly Rule 77.
Read second time. Ordered to third reading.
Read third time and amended. Ordered to second reading.
Read second time. Ordered to third reading.
From committee: Do pass. (Ayes 5. Noes 2.) (August 16).
Read second time and amended. Re-referred to Com. on APPR.
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 5. Noes 2.) (June 27).
From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.
From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.
In Senate. Read first time. To Com. on RLS. for assignment.
Read third time. Passed. Ordered to the Senate. (Ayes 48. Noes 22. Page 3592.)
Read second time. Ordered to third reading.
From committee: Do pass. (Ayes 12. Noes 5.) (January 19).
In committee: Hearing postponed by committee.
In committee: Set, first hearing. Referred to APPR. suspense file.
From committee: Do pass and re-refer to Com. on APPR. (Ayes 13. Noes 5.) (April 26). Re-referred to Com. on APPR.
From printer. May be heard in committee March 17.
Read first time. To print.
| Bill Text Versions | Format |
|---|---|
| AB369 | HTML |
| 02/14/11 - Introduced | |
| 05/21/12 - Amended Senate | |
| 06/20/12 - Amended Senate | |
| 07/03/12 - Amended Senate | |
| 08/24/12 - Amended Senate | |
| 09/11/12 - Enrolled |
| Document | Format |
|---|---|
| No related documents. |
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