Bill Text: CA AB539 | 2025-2026 | Regular Session | Amended
Bill Title: Health care coverage: prior authorizations.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Engrossed) 2026-07-02 - Read second time and amended. Re-referred to Com. on APPR. [AB539 Detail]
Download: California-2025-AB539-Amended.html
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Amended
IN
Senate
July 02, 2026 |
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Amended
IN
Assembly
April 28, 2025 |
CALIFORNIA LEGISLATURE—
2025–2026 REGULAR SESSION
Assembly Bill
No. 539
| Introduced by Assembly Member Schiavo |
February 11, 2025 |
An act to amend Section 1371.8 of the Health and Safety Code, and to amend Section 796.04 of the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 539, as amended, Schiavo.
Health care coverage: prior authorizations.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law provides that a health care service plan or a health insurer that authorizes a specific type of treatment by a health care provider shall not rescind or modify this authorization after the provider renders the health care service in good faith and pursuant to the authorization.
This bill would require a an approved prior
authorization for a health care service by a health care service plan or a health insurer requested by an in-network provider to remain valid for the period required by the treating provider for the course of the prescribed treatment, not to exceed a period of at least one year from the date of approval, or throughout the course of prescribed
treatment, if less than one year. Because a violation of the bill by a health care service plan would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1371.8 of the Health and Safety Code is amended to read:1371.8.
(a) A health care service plan that authorizes a specific type of treatment by a provider shall not rescind or modify this authorization after the provider renders the health care service in good faith and pursuant to the authorization for any reason, including, but not limited to, the plan’s subsequent rescission, cancellation, or modification of the enrollee’s or subscriber’s contract or the plan’s subsequent determination that it did not make an accurate determination of the enrollee’s or subscriber’s eligibility. This section shall not be construed to expand or alter the benefits available to the enrollee or subscriber under a plan. The Legislature finds and declares that by adopting the amendments made to this section by Assembly Bill 1324 of the 2007–08 Regular Session it does not intend to instruct a court as to whether or not the amendments are existing law.(b) A An approved prior authorization for a health care service requested by an in-network provider shall remain valid for the period required by the treating provider for the course of the prescribed treatment, not to exceed a period of at least one year from the date of approval, or throughout the course of prescribed treatment,
if less than one year.
(c) This section shall not be interpreted to permit a period of validity for a medication that is longer than a validity period established pursuant to state or federal law and regulation.
(d) The one-year validity period established in subdivision (b) does not apply if the enrollee changes plans within the one year period.
SEC. 2.
Section 796.04 of the Insurance Code is amended to read:796.04.
(a) A health insurer that provides coverage for hospital, medical, or surgical expenses that authorizes a specific type of treatment for services covered under a policyholder’s contract or plan by a provider shall not rescind or modify this authorization after the provider renders the health care service in good faith and pursuant to the authorization for any reason, including, but not limited to, the insurer’s subsequent rescission, cancellation, or modification of the insured’s or policyholder’s contract or the insurer’s subsequent determination that it did not make an accurate determination of the insured’s eligibility. This section shall not be construed to expand or alter the benefits available or the terms and conditions of the contract as may be agreed upon between a policyholder, certificate holder, or trust, and the insurer. The Legislature finds and declares that by adopting the amendments made to this section by Assembly Bill 1324 of the 2007–08 Regular Session it does not intend to instruct a court as to whether or not the amendments are existing law.(b) A An approved prior authorization for a health care service requested by an in-network provider shall remain valid for the period required by the
treating provider for the course of the prescribed treatment, not to exceed a period of at least one year from the date of approval, or throughout the course of prescribed treatment, if less than one year.
(c) This section shall not be interpreted to permit a period of validity for a medication that is longer than a validity period established pursuant to state or federal law and regulation.
(d) The one-year validity period established in subdivision (b) does not apply if the insured changes insurers within the one year period.
