CA AB3260

Requires health care service plans to make utilization review decisions within 72 hours for urgent requests and 5 business days for non-urgent requests, with automatic conversion to grievance if timelines are missed.

Expands independent medical review application deadline from 6 months to 12 months and requires plans to provide enrollees and representatives correspondence with the department and prohibits ex parte communications.

Establishes expedited grievance review for urgent cases requiring plan response within 72 hours and automatic resolution in favor of enrollee if plan fails to meet timeframes, with limited exceptions.

Applies similar utilization review and grievance requirements to health insurers, including 5 business day decision timelines for non-urgent requests and 72 hours for urgent requests, with automatic grievance conversion for missed deadlines.

Requires health insurers to acknowledge receipt of complaints within 24 hours if urgent or 5 calendar days if non-urgent, and provide department with requested information within same timeframes.