Amended IN Senate June 03, 2024 Amended IN Assembly April 29, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2198Introduced by Assembly Member FloraFebruary 07, 2024An act to amend Section 1374.196 of, and to add Section 1374.1965 to, the Health and Safety Code, and to amend Section 10133.12 of, and to add Section 10133.125 to, the Insurance Code, relating to health care. LEGISLATIVE COUNSEL'S DIGESTAB 2198, as amended, Flora. Health information. 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. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers to establish and maintain specified application programming interfaces (API), including patient access API, for the benefit of enrollees, insureds, and contracted providers.This bill would would, except for Medi-Cal dental managed care contracts, exclude a specialized plan or insurer that issues, sells, renews, or offers a contract or policy covering dental or vision services from the above-described API requirements, and would instead require a specialized plan or insurer that issues, sells, renews, or offers a contract or policy covering dental or vision services and meets specified enrollment requirements to comply with the above-described API requirements beginning January 1, 2027, or when final federal rules are implemented, whichever is later.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 1374.196 of the Health and Safety Code is amended to read:1374.196. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health care service plan shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a health care service plan to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.(e) A Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services is excluded from the requirements of this section.SEC. 2. Section 1374.1965 is added to the Health and Safety Code, to read:1374.1965. (a) Commencing January 1, 2027, or when final rules are implemented by the federal government, whichever is later, a specialized health care service plan plan, not subject to Section 1374.196, that issues, sells, renews, or offers a contract covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a dental or vision plan to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.(e) This section does not apply to a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services with 90,000 or fewer enrollees who are California residents across all dental or vision product lines.SEC. 3. Section 10133.12 of the Insurance Code is amended to read:10133.12. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health insurer shall establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a health insurer to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.(e) A Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services is excluded from the requirements of this section.SEC. 4. Section 10133.125 is added to the Insurance Code, to read:10133.125. (a) Commencing January 1, 2027, or when final rules are implemented by the federal government, whichever is later, a specialized health insurer insurer, not subject to Section 10133.12, that issues, sells, renews, or offers a policy covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of insureds and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a dental or vision insurer to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.(e) This section does not apply to a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services with 90,000 or fewer insureds who are California residents across all dental or vision product lines.
Amended IN Senate June 03, 2024 Amended IN Assembly April 29, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2198Introduced by Assembly Member FloraFebruary 07, 2024An act to amend Section 1374.196 of, and to add Section 1374.1965 to, the Health and Safety Code, and to amend Section 10133.12 of, and to add Section 10133.125 to, the Insurance Code, relating to health care. LEGISLATIVE COUNSEL'S DIGESTAB 2198, as amended, Flora. Health information. 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. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers to establish and maintain specified application programming interfaces (API), including patient access API, for the benefit of enrollees, insureds, and contracted providers.This bill would would, except for Medi-Cal dental managed care contracts, exclude a specialized plan or insurer that issues, sells, renews, or offers a contract or policy covering dental or vision services from the above-described API requirements, and would instead require a specialized plan or insurer that issues, sells, renews, or offers a contract or policy covering dental or vision services and meets specified enrollment requirements to comply with the above-described API requirements beginning January 1, 2027, or when final federal rules are implemented, whichever is later.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO
Amended IN Senate June 03, 2024 Amended IN Assembly April 29, 2024
Amended IN Senate June 03, 2024
Amended IN Assembly April 29, 2024
CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION
Assembly Bill
No. 2198
Introduced by Assembly Member FloraFebruary 07, 2024
Introduced by Assembly Member Flora
February 07, 2024
An act to amend Section 1374.196 of, and to add Section 1374.1965 to, the Health and Safety Code, and to amend Section 10133.12 of, and to add Section 10133.125 to, the Insurance Code, relating to health care.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 2198, as amended, Flora. Health information.
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. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers to establish and maintain specified application programming interfaces (API), including patient access API, for the benefit of enrollees, insureds, and contracted providers.This bill would would, except for Medi-Cal dental managed care contracts, exclude a specialized plan or insurer that issues, sells, renews, or offers a contract or policy covering dental or vision services from the above-described API requirements, and would instead require a specialized plan or insurer that issues, sells, renews, or offers a contract or policy covering dental or vision services and meets specified enrollment requirements to comply with the above-described API requirements beginning January 1, 2027, or when final federal rules are implemented, whichever is later.
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. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers to establish and maintain specified application programming interfaces (API), including patient access API, for the benefit of enrollees, insureds, and contracted providers.
This bill would would, except for Medi-Cal dental managed care contracts, exclude a specialized plan or insurer that issues, sells, renews, or offers a contract or policy covering dental or vision services from the above-described API requirements, and would instead require a specialized plan or insurer that issues, sells, renews, or offers a contract or policy covering dental or vision services and meets specified enrollment requirements to comply with the above-described API requirements beginning January 1, 2027, or when final federal rules are implemented, whichever is later.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 1374.196 of the Health and Safety Code is amended to read:1374.196. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health care service plan shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a health care service plan to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.(e) A Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services is excluded from the requirements of this section.SEC. 2. Section 1374.1965 is added to the Health and Safety Code, to read:1374.1965. (a) Commencing January 1, 2027, or when final rules are implemented by the federal government, whichever is later, a specialized health care service plan plan, not subject to Section 1374.196, that issues, sells, renews, or offers a contract covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a dental or vision plan to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.(e) This section does not apply to a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services with 90,000 or fewer enrollees who are California residents across all dental or vision product lines.SEC. 3. Section 10133.12 of the Insurance Code is amended to read:10133.12. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health insurer shall establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a health insurer to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.(e) A Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services is excluded from the requirements of this section.SEC. 4. Section 10133.125 is added to the Insurance Code, to read:10133.125. (a) Commencing January 1, 2027, or when final rules are implemented by the federal government, whichever is later, a specialized health insurer insurer, not subject to Section 10133.12, that issues, sells, renews, or offers a policy covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of insureds and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a dental or vision insurer to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.(e) This section does not apply to a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services with 90,000 or fewer insureds who are California residents across all dental or vision product lines.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. Section 1374.196 of the Health and Safety Code is amended to read:1374.196. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health care service plan shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a health care service plan to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.(e) A Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services is excluded from the requirements of this section.
SECTION 1. Section 1374.196 of the Health and Safety Code is amended to read:
### SECTION 1.
1374.196. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health care service plan shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a health care service plan to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.(e) A Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services is excluded from the requirements of this section.
1374.196. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health care service plan shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a health care service plan to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.(e) A Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services is excluded from the requirements of this section.
1374.196. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health care service plan shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a health care service plan to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.(e) A Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services is excluded from the requirements of this section.
1374.196. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health care service plan shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:
(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.
(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.
(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.
(b) In addition to the API described in subdivision (a), the department may require a health care service plan to establish and maintain the following API if and when final rules are published by the federal government:
(1) Provider access API.
(2) Prior authorization support API.
(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.
(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.
(e) A Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services is excluded from the requirements of this section.
SEC. 2. Section 1374.1965 is added to the Health and Safety Code, to read:1374.1965. (a) Commencing January 1, 2027, or when final rules are implemented by the federal government, whichever is later, a specialized health care service plan plan, not subject to Section 1374.196, that issues, sells, renews, or offers a contract covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a dental or vision plan to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.(e) This section does not apply to a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services with 90,000 or fewer enrollees who are California residents across all dental or vision product lines.
SEC. 2. Section 1374.1965 is added to the Health and Safety Code, to read:
### SEC. 2.
1374.1965. (a) Commencing January 1, 2027, or when final rules are implemented by the federal government, whichever is later, a specialized health care service plan plan, not subject to Section 1374.196, that issues, sells, renews, or offers a contract covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a dental or vision plan to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.(e) This section does not apply to a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services with 90,000 or fewer enrollees who are California residents across all dental or vision product lines.
1374.1965. (a) Commencing January 1, 2027, or when final rules are implemented by the federal government, whichever is later, a specialized health care service plan plan, not subject to Section 1374.196, that issues, sells, renews, or offers a contract covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a dental or vision plan to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.(e) This section does not apply to a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services with 90,000 or fewer enrollees who are California residents across all dental or vision product lines.
1374.1965. (a) Commencing January 1, 2027, or when final rules are implemented by the federal government, whichever is later, a specialized health care service plan plan, not subject to Section 1374.196, that issues, sells, renews, or offers a contract covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a dental or vision plan to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.(e) This section does not apply to a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services with 90,000 or fewer enrollees who are California residents across all dental or vision product lines.
1374.1965. (a) Commencing January 1, 2027, or when final rules are implemented by the federal government, whichever is later, a specialized health care service plan plan, not subject to Section 1374.196, that issues, sells, renews, or offers a contract covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:
(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.
(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.
(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.
(b) In addition to the API described in subdivision (a), the department may require a dental or vision plan to establish and maintain the following API if and when final rules are published by the federal government:
(1) Provider access API.
(2) Prior authorization support API.
(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.
(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.
(e) This section does not apply to a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services with 90,000 or fewer enrollees who are California residents across all dental or vision product lines.
SEC. 3. Section 10133.12 of the Insurance Code is amended to read:10133.12. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health insurer shall establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a health insurer to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.(e) A Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services is excluded from the requirements of this section.
SEC. 3. Section 10133.12 of the Insurance Code is amended to read:
### SEC. 3.
10133.12. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health insurer shall establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a health insurer to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.(e) A Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services is excluded from the requirements of this section.
10133.12. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health insurer shall establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a health insurer to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.(e) A Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services is excluded from the requirements of this section.
10133.12. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health insurer shall establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a health insurer to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.(e) A Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services is excluded from the requirements of this section.
10133.12. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health insurer shall establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:
(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.
(2) Provider directory API, as described in Section 422.120 of the Code of Federal Regulations.
(3) Payer-to-payer exchange API, as described in Section 422.119(f) of the Code of Federal Regulations.
(b) In addition to the API described in subdivision (a), the department may require a health insurer to establish and maintain the following API if and when final rules are published by the federal government:
(1) Provider access API.
(2) Prior authorization support API.
(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.
(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.
(e) A Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services is excluded from the requirements of this section.
SEC. 4. Section 10133.125 is added to the Insurance Code, to read:10133.125. (a) Commencing January 1, 2027, or when final rules are implemented by the federal government, whichever is later, a specialized health insurer insurer, not subject to Section 10133.12, that issues, sells, renews, or offers a policy covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of insureds and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a dental or vision insurer to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.(e) This section does not apply to a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services with 90,000 or fewer insureds who are California residents across all dental or vision product lines.
SEC. 4. Section 10133.125 is added to the Insurance Code, to read:
### SEC. 4.
10133.125. (a) Commencing January 1, 2027, or when final rules are implemented by the federal government, whichever is later, a specialized health insurer insurer, not subject to Section 10133.12, that issues, sells, renews, or offers a policy covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of insureds and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a dental or vision insurer to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.(e) This section does not apply to a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services with 90,000 or fewer insureds who are California residents across all dental or vision product lines.
10133.125. (a) Commencing January 1, 2027, or when final rules are implemented by the federal government, whichever is later, a specialized health insurer insurer, not subject to Section 10133.12, that issues, sells, renews, or offers a policy covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of insureds and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a dental or vision insurer to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.(e) This section does not apply to a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services with 90,000 or fewer insureds who are California residents across all dental or vision product lines.
10133.125. (a) Commencing January 1, 2027, or when final rules are implemented by the federal government, whichever is later, a specialized health insurer insurer, not subject to Section 10133.12, that issues, sells, renews, or offers a policy covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of insureds and contracted providers, as applicable:(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.(b) In addition to the API described in subdivision (a), the department may require a dental or vision insurer to establish and maintain the following API if and when final rules are published by the federal government:(1) Provider access API.(2) Prior authorization support API.(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.(e) This section does not apply to a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services with 90,000 or fewer insureds who are California residents across all dental or vision product lines.
10133.125. (a) Commencing January 1, 2027, or when final rules are implemented by the federal government, whichever is later, a specialized health insurer insurer, not subject to Section 10133.12, that issues, sells, renews, or offers a policy covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of insureds and contracted providers, as applicable:
(1) Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.
(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.
(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.
(b) In addition to the API described in subdivision (a), the department may require a dental or vision insurer to establish and maintain the following API if and when final rules are published by the federal government:
(1) Provider access API.
(2) Prior authorization support API.
(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.
(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.
(e) This section does not apply to a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services with 90,000 or fewer insureds who are California residents across all dental or vision product lines.