Bill Text: CA SB324 | 2023-2024 | Regular Session | Introduced

California Senate Bill 324

NOTE: There are more recent revisions of this legislation. Read Latest Draft

Bill Title: Health care coverage: endometriosis.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed) 2023-09-01 - September 1 hearing: Held in committee and under submission. [SB324 Detail]

Download: California-2023-SB324-Introduced.html

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill

No. 324

Introduced by Senator Limón

February 06, 2023

An act to add Section 1367.17 to the Health and Safety Code, and to add Section 10123.186 to the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL'S DIGEST

SB 324, as introduced, Limón. Health care coverage: prior authorization.

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 generally authorizes a health care service plan or health insurer to use prior authorization and other utilization review functions, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity.

This bill would prohibit a health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, from requiring prior authorization or other utilization review for laparoscopic surgery for endometriosis. Because a willful violation of these provisions 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.

Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES

The people of the State of California do enact as follows:

SECTION 1.

Section 1367.17 is added to the Health and Safety Code, to read:

1367.17.

A health care service plan contract issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.

SEC. 2.

Section 10123.186 is added to the Insurance Code, to read:

10123.186.

A health insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, shall not require prior authorization or other utilization review for laparoscopic surgery for endometriosis.

SEC. 3.

No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.