AB 2209 Summary

• Requires health care service plans and health insurers that develop and implement clinical pathways to follow specified procedures, including development by multidisciplinary physician groups and review by board-certified physician panels.

• Prohibits health care service plans and insurers from developing clinical pathways that discourage patient access to clinical trials.

• Mandates that clinical pathways be reviewed and updated at least annually, with prescribing practitioners able to request reviews when new treatment options become available.

• Requires public disclosure of each clinical pathway, including its scope, key clinical features, developer qualifications and conflicts of interest, panel member information, evidence sources, and the review and update process.

• Clarifies that clinical pathways relate to medical practice rather than coverage decisions, and that care provided under pathways remains subject to grievance, appeal, and independent medical review processes.