Matt Haney
- Democratic
- Assemblymember
- District 17
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 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 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 health care service plan contracts and health insurance policies that provide hospital, medical, or surgical coverage and are issued, amended, or renewed on or after January 1, 2021, to provide coverage for medically necessary treatment of mental health and substance use disorders under the same terms and conditions applied to other medical conditions, as specified. On and after January 1, 2027, this bill would prohibit concurrent or retrospective review of medical necessity of in-network health care services and benefits (1) for the first 28 days of a treatment plan for inpatient or residential substance use disorder stay at a specified licensed facility during each plan or policy year or (2) for outpatient services provided by specified certified programs for substance use disorder visits, except as specified. The bill would authorize, after the 29th day, in-network health care services and benefits for inpatient or residential substance use disorder care to be subject to concurrent review. On and after January 1, 2027, the bill would prohibit retrospective review of medical necessity for the first 28 days of intensive outpatient or partial hospitalization services for substance use disorder, but would authorize concurrent or retrospective review for day 29 and days thereafter of that stay or service. With respect to health care service plans, the bill would specify that its provisions do not apply to Medi-Cal behavioral health delivery systems or Medi-Cal managed care plan contracts. Because a willful violation of the bill's requirements 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.
In committee: Held under submission.
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 10. Noes 1.) (July 9).
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 64. Noes 5. Page 1977.)
Read second time. Ordered to third reading.
From committee: Do pass. (Ayes 11. Noes 1.) (May 23).
In committee: Set, first hearing. Referred to APPR. 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 17.
Read first time. To print.
| Bill Text Versions | Format |
|---|---|
| AB669 | HTML |
| 02/14/25 - Introduced | |
| 04/10/25 - Amended Assembly | |
| 04/28/25 - Amended Assembly | |
| 06/30/25 - Amended Senate | |
| 07/15/25 - Amended Senate |
| Document | Format |
|---|---|
| 04/18/25- Assembly Health | |
| 05/05/25- Assembly Appropriations | |
| 05/28/25- ASSEMBLY FLOOR ANALYSIS | |
| 07/07/25- Senate Health | |
| 08/15/25- Senate 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.