CA SB294

Requires health care service plans and disability insurers to automatically submit mental health and substance use disorder treatment denials, delays, or modifications for enrollees/insureds up to 26 years of age to the Independent Medical Review System within 24 hours if the decision is upheld or grievance remains unresolved, effective January 1, 2026.

Treats authorization request denials for mental health or substance use disorder treatment for young people up to 26 years of age as automatically filed grievances, eliminating the need for enrollees or insureds to separately initiate the grievance process.

Requires plans and insurers to provide written notice within 24 hours of automatic submission to the enrollee, provider, and relevant department, including information about the right to cancel the independent medical review and submit additional documentation.

Applies to denials based on lack of medical necessity and denials of experimental or investigational therapies for seriously debilitating or life-threatening mental health or substance use disorder conditions, with exceptions for Medi-Cal managed care plans.

Authorizes the Director of Managed Health Care and Insurance Commissioner to issue interim guidance and regulations to implement the bill, with quarterly public reporting required on automatic independent medical review cases.