Bill Text: CA AB2198 | 2023-2024 | Regular Session | Amended
Bill Title: Health information.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Engrossed) 2024-08-20 - Read second time. Ordered to third reading. [AB2198 Detail]
Download: California-2023-AB2198-Amended.html
Amended
IN
Senate
August 19, 2024 |
Amended
IN
Senate
June 17, 2024 |
Amended
IN
Senate
June 03, 2024 |
Amended
IN
Assembly
April 29, 2024 |
Introduced by Assembly Member Flora |
February 07, 2024 |
LEGISLATIVE COUNSEL'S DIGEST
This bill would, except for Medi-Cal dental managed care contracts, exclude a specialized plan or insurer that issues, sells, renews, or offers a contract or policy covering dental or vision services from the above-described API requirements, and would instead require a specialized plan or insurer that issues, sells, renews, or offers a
contract or policy covering dental or vision services and meets specified enrollment requirements to comply with the above-described API requirements beginning January 1, 2027, or when the final federal rules for impacted payers are implemented, whichever is later.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program:Bill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1374.196 of the Health and Safety Code is amended to read:1374.196.
(a) Commencing January 1,(1)Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.
(2)Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.
(3)Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.
(b)In addition to the API described in subdivision (a), the department may require a health care service plan to establish and
maintain the following API if and when final rules are published by the federal government:
(1)Provider access API.
(2)Prior authorization support API.
(c)
(e)Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services is excluded from the requirements of this section.
(a)Commencing January 1, 2027, or when the final federal rules for impacted payers are implemented, whichever is later, a specialized health care service plan, not subject to Section 1374.196, that issues, sells, renews, or offers a contract covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:
(1)Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.
(2)Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.
(3)Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.
(b)In addition to the API described in subdivision (a), the department may require a dental or vision plan to establish and maintain the following API if and when final rules are published by the federal government:
(1)Provider access API.
(2)Prior authorization support API.
(c)API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.
(d)This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.
SEC. 3.SEC. 2.
Section 10133.12 of the Insurance Code is amended to read:10133.12.
(a) Commencing January 1,(1)Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.
(2)Provider directory API, as described in Section 422.120 of the Code of Federal Regulations.
(3)Payer-to-payer exchange API, as described in Section 422.119(f) of the Code of Federal Regulations.
(b)In addition to the API described in subdivision (a), the department may require a health insurer to establish and maintain the following API if and when final rules are published by the federal government:
(1)Provider access API.
(2)Prior authorization support API.
(c)
(e)Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services is excluded from the requirements of this section.
(a)Commencing January 1, 2027, or when the final federal rules for impacted payers are implemented, whichever is later, a specialized health insurer, not subject to Section 10133.12, that issues, sells, renews, or offers a policy covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of insureds and contracted providers, as applicable:
(1)Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.
(2)Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.
(3)Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.
(b)In addition to the API described in subdivision (a), the department may require a dental or vision insurer to establish and maintain the following API if and when final rules are published by the federal government:
(1)Provider access API.
(2)Prior authorization support API.
(c)API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and
published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.
(d)This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.