Health care coverage: prior authorizations.

Senator Becker's health care legislation aims to streamline medical prior authorizations by preventing health plans and insurers from requiring advance approval for services that historically receive high authorization rates. Under the measure, plans must automatically exempt any covered service from prior authorization requirements for one year if they approved 90% or more of requests for that service in the previous calendar year.

The bill establishes new transparency requirements for California health plans and insurers. By March 15 annually, plans must publish on their websites a comprehensive list of services subject to prior authorization in the previous year, along with approval rates for each service. Plans must also prominently display which services qualify for exemption from authorization requirements and update all relevant policy documents to reflect these changes. The provisions apply specifically to in-network providers.

To standardize implementation, the legislation defines how plans must calculate approval rates - dividing the total number of approved requests for a specific service by the total number of authorization decisions made for that service during the calendar year. The bill adds parallel requirements to both the Health and Safety Code for managed care plans and the Insurance Code for traditional health insurers, ensuring consistent application across California's health coverage system.