John Harabedian
- Democratic
- Assemblymember
- District 41
Author
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 disability insurers by the Department of Insurance. Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including pursuant to contracts with various types of managed care plans. Existing law generally authorizes a health care service plan, including a Medi-Cal managed care plan, or disability insurer to use utilization review, 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. For a request prior to or concurrent with the provision of health care services, existing law requires utilization review decisions to be made within 5 business days from the plan's or insurer's receipt of the information reasonably necessary and requested by the plan or insurer to make the determination, or within 72 hours if the enrollee or insured faces an imminent and serious threat to their health or the normal timeframe would be detrimental to their life or health, as specified. This bill would change the timeline for prior or concurrent authorization requests to no more than 3 business days from the plan's or insurer's receipt via electronic submission, or 5 business days from receipt via submission that is not electronic, of the information reasonably necessary and requested by the plan or insurer to make the determination. The bill would require a utilization review decision to be made within 24 hours from receipt of a prior or concurrent authorization request via electronic submission, or 48 hours from receipt via submission that is not electronic, if the enrollee or insured faces an imminent and serious threat to their health or the normal timeframe would be detrimental to their life or health. Because a willful violation of this provision by a health care service plan would be a crime, the bill would impose a state-mandated local program. The bill would exclude Medi-Cal managed care plans from the above-described timeline changes. 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 3 p.m.
Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 67. Noes 2. Page 3219.).
In Assembly. Concurrence in Senate amendments pending.
Read third time. Passed. Ordered to the Assembly. (Ayes 30. Noes 0. Page 2656.).
Read second time. Ordered to third reading.
Read second time and amended. Ordered returned to second reading.
Read third time and amended. Ordered to second reading.
Read second time. Ordered to third reading.
From committee: Do pass. (Ayes 5. Noes 0.) (August 29).
Read second time and amended. Re-referred to Com. on APPR.
From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (July 9).
In Senate. Read first time. To Com. on RLS. for assignment.
Read third time. Passed. Ordered to the Senate. (Ayes 68. Noes 1. Page 1834.)
Read second time. Ordered to third reading.
From committee: Do pass. (Ayes 12. Noes 0.) (May 23).
In committee: Set, first hearing. Referred to suspense file.
Read second time and amended.
From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 13. Noes 0.) (April 22).
From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.
From printer. May be heard in committee March 13.
Read first time. To print.
| Bill Text Versions | Format |
|---|---|
| AB512 | HTML |
| 02/10/25 - Introduced | |
| 04/11/25 - Amended Assembly | |
| 04/28/25 - Amended Assembly | |
| 07/14/25 - Amended Senate | |
| 09/04/25 - Amended Senate | |
| 09/05/25 - Amended Senate | |
| 09/12/25 - Enrolled |
| Document | Format |
|---|---|
| 04/18/25- Assembly Health | |
| 05/12/25- Assembly Appropriations | |
| 05/28/25- ASSEMBLY FLOOR ANALYSIS | |
| 07/07/25- Senate Health | |
| 08/15/25- Senate Appropriations | |
| 08/29/25- Sen. Floor Analyses | |
| 09/08/25- Sen. Floor Analyses | |
| 09/10/25- ASSEMBLY FLOOR ANALYSIS | |
| 10/23/25- ASSEMBLY FLOOR ANALYSIS |
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