| 1 | | - | Assembly Bill No. 2198 CHAPTER 386An act to amend Section 1374.196 of the Health and Safety Code, and to amend Section 10133.12 of the Insurance Code, relating to health care. [ Approved by Governor September 22, 2024. Filed with Secretary of State September 22, 2024. ] LEGISLATIVE COUNSEL'S DIGESTAB 2198, 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 and makes a willful violation of the acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers, commencing January 1, 2024, to establish and maintain specified application programming interfaces (API), including patient access API, for the benefit of enrollees, insureds, and contracted providers. Existing law authorizes the departments to require health care service plans or health insurers, as applicable, to establish and maintain provider access API and prior authorization support API if and when final federal rules are published .This bill would instead require the departments, commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, to require health care service plans and health insurers to establish and maintain patient access API, provider access API, payer-to-payer API, and prior authorization API. The bill, until January 1, 2027, would authorize the departments to issue guidance relating to these provisions not subject to the Administrative Procedure Act, as specified. Because a violation of these requirements by a health care service plan would be a crime, this 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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES 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, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health care service plan to establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API.(2) Provider access API.(3) Payer-to-payer API.(4) Prior authorization API.(b) API described in subdivision (a) 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.(c) (1) Until January 1, 2027, the director may issue guidance to health care service plans regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). (2) In developing the guidance under this subdivision, the department shall seek input from the State Department of Health Care Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.SEC. 2. Section 10133.12 of the Insurance Code is amended to read:10133.12. (a) Commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health insurer to establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:(1) Patient access API.(2) Provider access API.(3) Payer-to-payer API.(4) Prior authorization API.(b) API described in subdivision (a) 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.(c) Until January 1, 2027, the commissioner may issue guidance to health insurers regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution. |
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| 1 | + | Enrolled September 03, 2024 Passed IN Senate August 28, 2024 Passed IN Assembly August 29, 2024 Amended IN Senate August 19, 2024 Amended IN Senate June 17, 2024 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 the Health and Safety Code, and to amend Section 10133.12 of the Insurance Code, relating to health care. LEGISLATIVE COUNSEL'S DIGESTAB 2198, 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 and makes a willful violation of the acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers, commencing January 1, 2024, to establish and maintain specified application programming interfaces (API), including patient access API, for the benefit of enrollees, insureds, and contracted providers. Existing law authorizes the departments to require health care service plans or health insurers, as applicable, to establish and maintain provider access API and prior authorization support API if and when final federal rules are published .This bill would instead require the departments, commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, to require health care service plans and health insurers to establish and maintain patient access API, provider access API, payer-to-payer API, and prior authorization API. The bill, until January 1, 2027, would authorize the departments to issue guidance relating to these provisions not subject to the Administrative Procedure Act, as specified. Because a violation of these requirements by a health care service plan would be a crime, this 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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES 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, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health care service plan to establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API.(2) Provider access API.(3) Payer-to-payer API.(4) Prior authorization API.(b) API described in subdivision (a) 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.(c) (1) Until January 1, 2027, the director may issue guidance to health care service plans regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). (2) In developing the guidance under this subdivision, the department shall seek input from the State Department of Health Care Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.SEC. 2. Section 10133.12 of the Insurance Code is amended to read:10133.12. (a) Commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health insurer to establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:(1) Patient access API.(2) Provider access API.(3) Payer-to-payer API.(4) Prior authorization API.(b) API described in subdivision (a) 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.(c) Until January 1, 2027, the commissioner may issue guidance to health insurers regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution. |
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| 14 | 27 | | |
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| 15 | 28 | | LEGISLATIVE COUNSEL'S DIGEST |
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| 16 | 29 | | |
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| 17 | 30 | | ## LEGISLATIVE COUNSEL'S DIGEST |
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| 18 | 31 | | |
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| 19 | 32 | | AB 2198, Flora. Health information. |
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| 20 | 33 | | |
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| 21 | 34 | | 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 acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers, commencing January 1, 2024, to establish and maintain specified application programming interfaces (API), including patient access API, for the benefit of enrollees, insureds, and contracted providers. Existing law authorizes the departments to require health care service plans or health insurers, as applicable, to establish and maintain provider access API and prior authorization support API if and when final federal rules are published .This bill would instead require the departments, commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, to require health care service plans and health insurers to establish and maintain patient access API, provider access API, payer-to-payer API, and prior authorization API. The bill, until January 1, 2027, would authorize the departments to issue guidance relating to these provisions not subject to the Administrative Procedure Act, as specified. Because a violation of these requirements by a health care service plan would be a crime, this 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. |
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| 22 | 35 | | |
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| 23 | 36 | | 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 acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers, commencing January 1, 2024, to establish and maintain specified application programming interfaces (API), including patient access API, for the benefit of enrollees, insureds, and contracted providers. Existing law authorizes the departments to require health care service plans or health insurers, as applicable, to establish and maintain provider access API and prior authorization support API if and when final federal rules are published . |
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| 24 | 37 | | |
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| 25 | 38 | | This bill would instead require the departments, commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, to require health care service plans and health insurers to establish and maintain patient access API, provider access API, payer-to-payer API, and prior authorization API. The bill, until January 1, 2027, would authorize the departments to issue guidance relating to these provisions not subject to the Administrative Procedure Act, as specified. Because a violation of these requirements by a health care service plan would be a crime, this bill would impose a state-mandated local program. |
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| 26 | 39 | | |
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| 27 | 40 | | 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. |
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| 28 | 41 | | |
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| 29 | 42 | | This bill would provide that no reimbursement is required by this act for a specified reason. |
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| 30 | 43 | | |
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| 31 | 44 | | ## Digest Key |
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| 32 | 45 | | |
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| 33 | 46 | | ## Bill Text |
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| 34 | 47 | | |
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| 35 | 48 | | 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, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health care service plan to establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API.(2) Provider access API.(3) Payer-to-payer API.(4) Prior authorization API.(b) API described in subdivision (a) 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.(c) (1) Until January 1, 2027, the director may issue guidance to health care service plans regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). (2) In developing the guidance under this subdivision, the department shall seek input from the State Department of Health Care Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.SEC. 2. Section 10133.12 of the Insurance Code is amended to read:10133.12. (a) Commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health insurer to establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:(1) Patient access API.(2) Provider access API.(3) Payer-to-payer API.(4) Prior authorization API.(b) API described in subdivision (a) 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.(c) Until January 1, 2027, the commissioner may issue guidance to health insurers regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution. |
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| 36 | 49 | | |
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| 37 | 50 | | The people of the State of California do enact as follows: |
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| 38 | 51 | | |
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| 39 | 52 | | ## The people of the State of California do enact as follows: |
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| 40 | 53 | | |
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| 41 | 54 | | SECTION 1. Section 1374.196 of the Health and Safety Code is amended to read:1374.196. (a) Commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health care service plan to establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API.(2) Provider access API.(3) Payer-to-payer API.(4) Prior authorization API.(b) API described in subdivision (a) 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.(c) (1) Until January 1, 2027, the director may issue guidance to health care service plans regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). (2) In developing the guidance under this subdivision, the department shall seek input from the State Department of Health Care Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27. |
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| 42 | 55 | | |
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| 43 | 56 | | SECTION 1. Section 1374.196 of the Health and Safety Code is amended to read: |
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| 44 | 57 | | |
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| 45 | 58 | | ### SECTION 1. |
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| 46 | 59 | | |
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| 47 | 60 | | 1374.196. (a) Commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health care service plan to establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API.(2) Provider access API.(3) Payer-to-payer API.(4) Prior authorization API.(b) API described in subdivision (a) 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.(c) (1) Until January 1, 2027, the director may issue guidance to health care service plans regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). (2) In developing the guidance under this subdivision, the department shall seek input from the State Department of Health Care Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27. |
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| 48 | 61 | | |
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| 49 | 62 | | 1374.196. (a) Commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health care service plan to establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API.(2) Provider access API.(3) Payer-to-payer API.(4) Prior authorization API.(b) API described in subdivision (a) 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.(c) (1) Until January 1, 2027, the director may issue guidance to health care service plans regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). (2) In developing the guidance under this subdivision, the department shall seek input from the State Department of Health Care Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27. |
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| 50 | 63 | | |
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| 51 | 64 | | 1374.196. (a) Commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health care service plan to establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access API.(2) Provider access API.(3) Payer-to-payer API.(4) Prior authorization API.(b) API described in subdivision (a) 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.(c) (1) Until January 1, 2027, the director may issue guidance to health care service plans regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). (2) In developing the guidance under this subdivision, the department shall seek input from the State Department of Health Care Services.(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27. |
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| 52 | 65 | | |
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| 53 | 66 | | |
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| 54 | 67 | | |
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| 55 | 68 | | 1374.196. (a) Commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health care service plan to establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable: |
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| 56 | 69 | | |
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| 57 | 70 | | (1) Patient access API. |
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| 58 | 71 | | |
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| 59 | 72 | | (2) Provider access API. |
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| 60 | 73 | | |
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| 61 | 74 | | (3) Payer-to-payer API. |
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| 62 | 75 | | |
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| 63 | 76 | | (4) Prior authorization API. |
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| 64 | 77 | | |
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| 65 | 78 | | (b) API described in subdivision (a) 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. |
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| 66 | 79 | | |
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| 67 | 80 | | (c) (1) Until January 1, 2027, the director may issue guidance to health care service plans regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). |
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| 68 | 81 | | |
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| 69 | 82 | | (2) In developing the guidance under this subdivision, the department shall seek input from the State Department of Health Care Services. |
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| 70 | 83 | | |
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| 71 | 84 | | (d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27. |
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| 72 | 85 | | |
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| 73 | 86 | | SEC. 2. Section 10133.12 of the Insurance Code is amended to read:10133.12. (a) Commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health insurer to establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:(1) Patient access API.(2) Provider access API.(3) Payer-to-payer API.(4) Prior authorization API.(b) API described in subdivision (a) 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.(c) Until January 1, 2027, the commissioner may issue guidance to health insurers regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15. |
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| 74 | 87 | | |
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| 75 | 88 | | SEC. 2. Section 10133.12 of the Insurance Code is amended to read: |
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| 76 | 89 | | |
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| 77 | 90 | | ### SEC. 2. |
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| 78 | 91 | | |
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| 79 | 92 | | 10133.12. (a) Commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health insurer to establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:(1) Patient access API.(2) Provider access API.(3) Payer-to-payer API.(4) Prior authorization API.(b) API described in subdivision (a) 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.(c) Until January 1, 2027, the commissioner may issue guidance to health insurers regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15. |
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| 80 | 93 | | |
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| 81 | 94 | | 10133.12. (a) Commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health insurer to establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:(1) Patient access API.(2) Provider access API.(3) Payer-to-payer API.(4) Prior authorization API.(b) API described in subdivision (a) 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.(c) Until January 1, 2027, the commissioner may issue guidance to health insurers regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15. |
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| 82 | 95 | | |
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| 83 | 96 | | 10133.12. (a) Commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health insurer to establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:(1) Patient access API.(2) Provider access API.(3) Payer-to-payer API.(4) Prior authorization API.(b) API described in subdivision (a) 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.(c) Until January 1, 2027, the commissioner may issue guidance to health insurers regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15. |
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| 84 | 97 | | |
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| 85 | 98 | | |
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| 86 | 99 | | |
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| 87 | 100 | | 10133.12. (a) Commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health insurer to establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable: |
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| 88 | 101 | | |
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| 89 | 102 | | (1) Patient access API. |
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| 90 | 103 | | |
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| 91 | 104 | | (2) Provider access API. |
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| 92 | 105 | | |
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| 93 | 106 | | (3) Payer-to-payer API. |
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| 94 | 107 | | |
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| 95 | 108 | | (4) Prior authorization API. |
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| 96 | 109 | | |
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| 97 | 110 | | (b) API described in subdivision (a) 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. |
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| 98 | 111 | | |
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| 99 | 112 | | (c) Until January 1, 2027, the commissioner may issue guidance to health insurers regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). |
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| 100 | 113 | | |
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| 101 | 114 | | (d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15. |
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| 102 | 115 | | |
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| 103 | 116 | | SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution. |
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| 104 | 117 | | |
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| 105 | 118 | | SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution. |
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| 106 | 119 | | |
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| 107 | 120 | | SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution. |
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| 108 | 121 | | |
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| 109 | 122 | | ### SEC. 3. |
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