Health care coverage: prior authorizations.

Senator Becker's health care legislation aims to streamline prior authorization requirements by identifying and eliminating approvals for commonly accepted medical services. The measure directs California's Departments of Managed Health Care and Insurance to collect comprehensive data from health plans and insurers about their prior authorization practices and approval rates.

By July 2027, the departments must publish lists of frequently approved services that will no longer require prior authorization. Health plans and insurers must cease requiring advance approval for these services no later than January 2028. The bill allows plans to maintain prior authorization requirements for certain categories, including experimental treatments, off-label drug uses, and services from out-of-network providers.

Plans may reinstate prior authorization requirements for individual providers who demonstrate patterns of fraud or clinically inappropriate care. The departments must evaluate the impact of these changes through mandatory reporting from health plans and publish their findings within four years of implementation. The provisions apply to most health plans and insurers but exclude specialized plans and Medi-Cal managed care contracts.

The measure includes safeguards to prevent delegation of compliance responsibilities without explicit contractual agreements. All provisions sunset on January 1, 2034, allowing for assessment of the program's effectiveness. The departments may implement these requirements through administrative guidance rather than formal rulemaking while consulting with each other before issuing instructions to their respective regulated entities.