CA SB363

Requires health care service plans and health insurers to annually report all treatment denials and modifications to state regulators starting June 1, 2026, categorized by type of care (surgical/medical or behavioral), diagnosis, age, and reason for denial

Imposes administrative penalties on plans/insurers with 10+ independent medical reviews per year if more than 50% of those reviews result in overturned or reversed treatment denials within any single care category

Establishes escalating penalties: minimum $25,000 for first violation, $50,000-$200,000 for second violation, and minimum $500,000 for each subsequent violation, with penalty amounts adjusted every five years for inflation starting January 1, 2031

Creates the Managed Care Independent Medical Review Administrative Penalties Subaccount and the Health Insurance Independent Medical Review Administrative Penalties Fund to collect penalty revenue, which can be used to offset implementation costs

Requires the Department of Managed Health Care and Department of Insurance to publish annual reports analyzing denial data and independent medical review outcomes beginning in 2028