Health care coverage: prior authorizations.

Assembly Member Schiavo's health care coverage legislation establishes new duration requirements for prior authorizations issued by California health plans and insurers, mandating that approvals remain valid for at least one year or throughout the prescribed course of treatment if shorter.

The measure builds upon existing state law, which already prohibits health plans and insurers from rescinding or modifying treatment authorizations after services have been provided in good faith. Under the proposed changes, prior authorizations would need to maintain their validity for a minimum 12-month period from the approval date, unless the authorized treatment is expected to conclude sooner. The requirements would apply equally to health care service plans regulated by the Department of Managed Health Care and health insurers overseen by the Department of Insurance.

The bill designates violations by health care service plans as criminal offenses under state law, making it a state-mandated local program. However, the measure specifies that no state reimbursement will be required for local agencies or school districts, as any costs would stem from changes to crime definitions under the California Constitution.