CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Senate Bill No. 324Introduced by Senator LimnFebruary 06, 2023 An act to add Section 1367.17 to the Health and Safety Code, and to add Section 10123.186 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTSB 324, as introduced, Limn. Health care coverage: prior authorization. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use prior authorization and other utilization review functions, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity.This bill would prohibit a health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, from requiring prior authorization or other utilization review for laparoscopic surgery for endometriosis. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.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 1367.17 is added to the Health and Safety Code, to read:1367.17. A health care service plan contract issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.SEC. 2. Section 10123.186 is added to the Insurance Code, to read:10123.186. A health insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.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.
CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Senate Bill No. 324Introduced by Senator LimnFebruary 06, 2023 An act to add Section 1367.17 to the Health and Safety Code, and to add Section 10123.186 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTSB 324, as introduced, Limn. Health care coverage: prior authorization. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use prior authorization and other utilization review functions, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity.This bill would prohibit a health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, from requiring prior authorization or other utilization review for laparoscopic surgery for endometriosis. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES
CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION
Senate Bill
No. 324
Introduced by Senator LimnFebruary 06, 2023
Introduced by Senator Limn
February 06, 2023
An act to add Section 1367.17 to the Health and Safety Code, and to add Section 10123.186 to the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
SB 324, as introduced, Limn. Health care coverage: prior authorization.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use prior authorization and other utilization review functions, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity.This bill would prohibit a health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, from requiring prior authorization or other utilization review for laparoscopic surgery for endometriosis. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use prior authorization and other utilization review functions, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity.
This bill would prohibit a health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, from requiring prior authorization or other utilization review for laparoscopic surgery for endometriosis. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 1367.17 is added to the Health and Safety Code, to read:1367.17. A health care service plan contract issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.SEC. 2. Section 10123.186 is added to the Insurance Code, to read:10123.186. A health insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.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.
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 1367.17 is added to the Health and Safety Code, to read:1367.17. A health care service plan contract issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.
SECTION 1. Section 1367.17 is added to the Health and Safety Code, to read:
### SECTION 1.
1367.17. A health care service plan contract issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.
1367.17. A health care service plan contract issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.
1367.17. A health care service plan contract issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.
1367.17. A health care service plan contract issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.
SEC. 2. Section 10123.186 is added to the Insurance Code, to read:10123.186. A health insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.
SEC. 2. Section 10123.186 is added to the Insurance Code, to read:
### SEC. 2.
10123.186. A health insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.
10123.186. A health insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.
10123.186. A health insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.
10123.186. A health insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.
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.
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.
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.
### SEC. 3.