California 2019-2020 Regular Session

California Senate Bill SB1033 Compare Versions

Only one version of the bill is available at this time.

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1	1	CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Senate Bill No. 1033Introduced by Senator PanFebruary 14, 2020 An act to add Section 1363.6 to the Health and Safety Code, and to add Section 10123.136 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTSB 1033, as introduced, Pan. Health care coverage: utilization review criteria.Existing law provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer to establish criteria or guidelines that meet specified requirements to be used to determine whether or not to authorize, modify, or deny health care services.This bill would authorize the Department of Managed Health Care and the Insurance Commissioner, as appropriate, to review a plans or insurers clinical criteria, guidelines, and utilization management policies to ensure compliance with existing law. If the criteria and guidelines are not in compliance with existing law, the bill would authorize the Director of the Department of Managed Health Care or the commissioner to issue a corrective action and send the matter to enforcement, if necessary. Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1363.6 is added to the Health and Safety Code, to read:1363.6. The department may review a plans clinical criteria, guidelines, and utilization management policies established pursuant to Section 1363.5, 1367.01, or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the director shall issue a corrective action and, if necessary, send the matter to enforcement.SEC. 2. Section 10123.136 is added to the Insurance Code, to read:10123.136. The commissioner may review an insurers clinical criteria, guidelines, and utilization management policies established pursuant to Section 10123.135 or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the commissioner shall issue a corrective action and, if necessary, send the matter to enforcement.
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3	3	CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Senate Bill No. 1033Introduced by Senator PanFebruary 14, 2020 An act to add Section 1363.6 to the Health and Safety Code, and to add Section 10123.136 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTSB 1033, as introduced, Pan. Health care coverage: utilization review criteria.Existing law provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer to establish criteria or guidelines that meet specified requirements to be used to determine whether or not to authorize, modify, or deny health care services.This bill would authorize the Department of Managed Health Care and the Insurance Commissioner, as appropriate, to review a plans or insurers clinical criteria, guidelines, and utilization management policies to ensure compliance with existing law. If the criteria and guidelines are not in compliance with existing law, the bill would authorize the Director of the Department of Managed Health Care or the commissioner to issue a corrective action and send the matter to enforcement, if necessary. Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO
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9	9	CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION
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11	11	Senate Bill
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13	13	No. 1033
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15	15	Introduced by Senator PanFebruary 14, 2020
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17	17	Introduced by Senator Pan
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20	20	An act to add Section 1363.6 to the Health and Safety Code, and to add Section 10123.136 to the Insurance Code, relating to health care coverage.
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22	22	LEGISLATIVE COUNSEL'S DIGEST
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24	24	## LEGISLATIVE COUNSEL'S DIGEST
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26	26	SB 1033, as introduced, Pan. Health care coverage: utilization review criteria.
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28	28	Existing law provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer to establish criteria or guidelines that meet specified requirements to be used to determine whether or not to authorize, modify, or deny health care services.This bill would authorize the Department of Managed Health Care and the Insurance Commissioner, as appropriate, to review a plans or insurers clinical criteria, guidelines, and utilization management policies to ensure compliance with existing law. If the criteria and guidelines are not in compliance with existing law, the bill would authorize the Director of the Department of Managed Health Care or the commissioner to issue a corrective action and send the matter to enforcement, if necessary.
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30	30	Existing law provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer to establish criteria or guidelines that meet specified requirements to be used to determine whether or not to authorize, modify, or deny health care services.
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32	32	This bill would authorize the Department of Managed Health Care and the Insurance Commissioner, as appropriate, to review a plans or insurers clinical criteria, guidelines, and utilization management policies to ensure compliance with existing law. If the criteria and guidelines are not in compliance with existing law, the bill would authorize the Director of the Department of Managed Health Care or the commissioner to issue a corrective action and send the matter to enforcement, if necessary.
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34	34	## Digest Key
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36	36	## Bill Text
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38	38	The people of the State of California do enact as follows:SECTION 1. Section 1363.6 is added to the Health and Safety Code, to read:1363.6. The department may review a plans clinical criteria, guidelines, and utilization management policies established pursuant to Section 1363.5, 1367.01, or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the director shall issue a corrective action and, if necessary, send the matter to enforcement.SEC. 2. Section 10123.136 is added to the Insurance Code, to read:10123.136. The commissioner may review an insurers clinical criteria, guidelines, and utilization management policies established pursuant to Section 10123.135 or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the commissioner shall issue a corrective action and, if necessary, send the matter to enforcement.
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40	40	The people of the State of California do enact as follows:
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42	42	## The people of the State of California do enact as follows:
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44	44	SECTION 1. Section 1363.6 is added to the Health and Safety Code, to read:1363.6. The department may review a plans clinical criteria, guidelines, and utilization management policies established pursuant to Section 1363.5, 1367.01, or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the director shall issue a corrective action and, if necessary, send the matter to enforcement.
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46	46	SECTION 1. Section 1363.6 is added to the Health and Safety Code, to read:
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48	48	### SECTION 1.
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50	50	1363.6. The department may review a plans clinical criteria, guidelines, and utilization management policies established pursuant to Section 1363.5, 1367.01, or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the director shall issue a corrective action and, if necessary, send the matter to enforcement.
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52	52	1363.6. The department may review a plans clinical criteria, guidelines, and utilization management policies established pursuant to Section 1363.5, 1367.01, or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the director shall issue a corrective action and, if necessary, send the matter to enforcement.
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54	54	1363.6. The department may review a plans clinical criteria, guidelines, and utilization management policies established pursuant to Section 1363.5, 1367.01, or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the director shall issue a corrective action and, if necessary, send the matter to enforcement.
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58	58	1363.6. The department may review a plans clinical criteria, guidelines, and utilization management policies established pursuant to Section 1363.5, 1367.01, or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the director shall issue a corrective action and, if necessary, send the matter to enforcement.
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60	60	SEC. 2. Section 10123.136 is added to the Insurance Code, to read:10123.136. The commissioner may review an insurers clinical criteria, guidelines, and utilization management policies established pursuant to Section 10123.135 or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the commissioner shall issue a corrective action and, if necessary, send the matter to enforcement.
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62	62	SEC. 2. Section 10123.136 is added to the Insurance Code, to read:
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64	64	### SEC. 2.
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66	66	10123.136. The commissioner may review an insurers clinical criteria, guidelines, and utilization management policies established pursuant to Section 10123.135 or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the commissioner shall issue a corrective action and, if necessary, send the matter to enforcement.
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68	68	10123.136. The commissioner may review an insurers clinical criteria, guidelines, and utilization management policies established pursuant to Section 10123.135 or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the commissioner shall issue a corrective action and, if necessary, send the matter to enforcement.
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70	70	10123.136. The commissioner may review an insurers clinical criteria, guidelines, and utilization management policies established pursuant to Section 10123.135 or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the commissioner shall issue a corrective action and, if necessary, send the matter to enforcement.
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74	74	10123.136. The commissioner may review an insurers clinical criteria, guidelines, and utilization management policies established pursuant to Section 10123.135 or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the commissioner shall issue a corrective action and, if necessary, send the matter to enforcement.