Health care coverage: prior authorization.
If passed, AB512 will impact the regulation of health care service plans under the Knox-Keene Health Care Service Plan Act of 1975 and the Insurance Code. By imposing stricter timelines, the bill emphasizes prompt decision-making from insurers regarding medical necessity evaluations. The bill also raises the stakes by designating willful violations of these provisions as crimes, which could lead to state-mandated local programs, raising questions about enforcement and compliance. Additionally, it states that no reimbursement is required for local agencies or school districts, reflecting a fiscal consideration in implementing the changes.
Assembly Bill 512, introduced by Assembly Member Harabedian, aims to amend existing provisions regarding health care coverage, specifically focusing on prior authorization processes. The bill modifies the timelines for health care service plans and disability insurers to make utilization review decisions. Under current law, decisions must typically be made within 5 business days, or 72 hours if there is an imminent health threat. AB512 seeks to shorten these periods to 48 hours for standard requests and 24 hours for urgent requests. This change is intended to improve access to necessary health care services and reduce delays that would adversely affect patients' health outcomes.
The sentiment around AB512 is mixed. Supporters argue it is a necessary step to facilitate quicker health care access at a critical time, especially as patients could face significant health risks due to delayed authorizations. On the other hand, there are concerns about the capacity of insurers and health plans to comply with tighter deadlines without sacrificing the quality of health care determinations. Opponents warn that such a rapid decision-making process may inadvertently lead to insufficient analysis of complex medical cases, potentially reducing the quality of patient care.
A notable point of contention in the discussion of AB512 is the balance between regulatory intervention and the autonomy of health care providers and insurers. Supporters assert that immediate access to necessary treatments is a priority that justifies the changes, while critics caution that the haste in approval processes may undermine the thorough evaluations typically necessary for determining medical necessity. Furthermore, the bill's crime designation for violations raises apprehensions about how this will be enforced and how that could affect the working relationship between providers and insurers.