CA SB516

By July 1, 2025, the Department of Managed Health Care and Department of Insurance must issue instructions requiring health care service plans and health insurers to report data on health care services subject to prior authorization, including approval rates and other relevant metrics.

Health care service plans and health insurers must submit required reports by December 31, 2025, and must obtain information from any delegated entities handling prior authorization decisions.

By December 31, 2026, each department must publish a list of health care services, items, and supplies most frequently approved (at a threshold rate not exceeding 90 percent) and may consider factors such as clinical practice guidelines, fraud potential, cost savings, and quality of care improvements when determining whether to eliminate prior authorization requirements.

Health care service plans and health insurers must cease requiring prior authorization for listed services by a date specified by their respective department, but may petition to reinstate prior authorization upon showing good cause, with department decisions required within 60 days.

By four years after the cessation date, each department must publish a report on the impact of eliminating prior authorization requirements; these provisions expire January 1, 2032.