Plain English Breakdown
The official status shows the governor vetoed the bill, but it is unclear if lawmakers later overrode the veto based on the provided text.
AB-512: Faster Rules for Health Care Approval Requests
This vetoed bill would have shortened the time health plans and disability insurers must take to approve or deny medical care requests, but it did not apply to Medi-Cal managed care plans.
What This Bill Does
- Changes the deadline for standard approval requests to no more than three business days if sent electronically, or five business days if sent by other methods.
- Shortens emergency decision times to within 24 hours for electronic submissions and 48 hours for non-electronic ones when a patient faces an imminent and serious threat to their health.
- Excludes Medi-Cal managed care plans from these new timeline requirements so they keep the current rules.
- States that willfully breaking these time limits by a health plan would be considered a crime.
Who It Names or Affects
- Health care service plans regulated under the Knox-Keene Act
- Disability insurers regulated by the Department of Insurance
- Patients enrolled in non-Medi-Cal managed care or disability insurance who need prior authorization for services
Terms To Know
- Prior Authorization
- A rule requiring a patient to get approval from their health plan before receiving certain medical treatments.
- Utilization Review
- The process where licensed professionals check if a requested service is medically necessary and approve, modify, delay, or deny it.
Limits and Unknowns
- This bill was vetoed by the governor and did not become law.
- Medi-Cal managed care plans are excluded from these new time limits.
- The bill states that no state reimbursement is required for local agencies, though it does not specify the reason.