Health care coverage reporting.

Assembly Member Ortega's health care coverage reporting legislation establishes new transparency requirements for California health insurers and health care service plans that use prior authorization. Beginning February 2026, these entities must publicly report detailed prior authorization data on their websites, including approval and denial rates, processing times, and lists of services requiring authorization.

The measure creates annual reporting obligations for claims processing and dispute resolution, requiring insurers and plans to submit comprehensive data about denied, adjusted, and contested claims. This information must be disaggregated by factors including network status, demographic categories, and specific medical procedures. The Department of Managed Health Care and Department of Insurance will publish this data on their websites starting April 2027, with privacy protections in place to safeguard patient information.

Health insurers and plans must also track and report claims processed using artificial intelligence or predictive algorithms. The legislation authorizes regulatory agencies to establish reporting formats, verify submitted data, and impose penalties for non-compliance. Contracted entities performing prior authorization must provide their data to insurers and plans for public disclosure.

The Departments of Managed Health Care and Insurance will implement these requirements through existing resources, with no new appropriations required. The measure includes enforcement provisions allowing regulators to reject deficient reports and assess administrative penalties against non-compliant entities.