CA SB238

Requires health care service plans and disability insurers to automatically submit denials, modifications, or delays of mental health or substance use disorder services to the Independent Medical Review System within 24 hours for enrollees/insureds up to 26 years of age, without requiring a grievance filing, effective July 1, 2024.

Also requires automatic submission for denials, modifications, or delays of experimental or investigational therapies for seriously debilitating or life-threatening mental health or substance use disorder conditions in the same age group.

Mandates insurers notify the appropriate department, the enrollee/insured, their representative, and their provider within 24 hours, including notification that the review can be cancelled at any time before determination.

Excludes Medi-Cal managed care plan contracts from these requirements.

Authorizes the Insurance Commissioner to issue guidance by January 1, 2027 and promulgate regulations under the Administrative Procedure Act to implement and enforce the provisions.