CA AB669

Prohibits health plans and insurers from conducting concurrent or retrospective medical necessity reviews for the first 28 days of inpatient or residential substance use disorder treatment at licensed facilities, effective January 1, 2027

Exempts outpatient substance use disorder visits at certified programs from concurrent or retrospective review and other utilization management requirements

Limits concurrent review after day 28 to no more frequent than two-week intervals, with 24-hour notice required if insurers determine continued care is no longer medically necessary

Requires insurers to continue coverage during appeals and prohibits patient discharge until all internal and external appeals are exhausted; facilities cannot bill patients beyond standard copayments, deductibles, and coinsurance

Mandates use of American Society of Addiction Medicine (ASAM) criteria for all medical necessity determinations and requires written discharge plans; excludes Medi-Cal behavioral health delivery systems and managed care plans from these requirements