Monique Limón
- Democratic
- Senator
- District 19
Author
(1) 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 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. This bill would prohibit a health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, from requiring prior authorization or other utilization review for any clinically indicated treatment for endometriosis, as determined by the treating physician and consistent with nationally recognized evidence-based clinical guidelines. 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. (2) Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law sets forth a schedule of benefits under the Medi-Cal program. This bill would add any clinically indicated treatment for endometriosis, as determined by the treating physician and consistent with nationally recognized evidence-based clinical guidelines, as a covered benefit under Medi-Cal without prior authorization or other utilization review. (3) 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.
September 1 hearing: Held in committee and under submission.
August 23 set for first hearing. Placed on suspense file.
From committee: Do pass and re-refer to Com. on APPR. (Ayes 12. Noes 2.) (June 27). Re-referred to Com. on APPR.
In Assembly. Read first time. Held at Desk.
Read third time. Passed. (Ayes 31. Noes 7. Page 1270.) Ordered to the Assembly.
Read second time. Ordered to third reading.
From committee: Do pass. (Ayes 5. Noes 1. Page 1165.) (May 18).
Set for hearing May 18.
April 24 hearing: Placed on APPR suspense file.
Set for hearing April 24.
From committee: Do pass and re-refer to Com. on APPR. (Ayes 10. Noes 1. Page 710.) (April 12). Re-referred to Com. on APPR.
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
Set for hearing April 12.
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
From printer. May be acted upon on or after March 9.
Introduced. Read first time. To Com. on RLS. for assignment. To print.
| Bill Text Versions | Format |
|---|---|
| SB324 | HTML |
| 02/06/23 - Introduced | |
| 03/09/23 - Amended Senate | |
| 03/30/23 - Amended Senate |
| Document | Format |
|---|---|
| 04/10/23- Senate Health | |
| 04/21/23- Senate Appropriations | |
| 05/20/23- Sen. Floor Analyses | |
| 06/23/23- Assembly Health | |
| 08/21/23- Assembly Appropriations |
Data on Open States is updated periodically throughout the day from the official website of the California State Legislature.
If you notice any inconsistencies with these official sources, feel free to file an issue.