Plain English Breakdown
The phrase 'period of at least one year... or throughout the course of prescribed treatment, if less than one year' combined with 'not to exceed' creates ambiguity about whether there is a hard cap on validity periods longer than one year.
Health Care Coverage: Prior Authorization Validity
AB-539 requires health plans to keep approved prior authorizations valid for the full course of treatment or at least one year, whichever is shorter.
What This Bill Does
- Requires an approved prior authorization from a health plan to stay valid for the time needed by the treating provider for the prescribed treatment.
Who It Names or Affects
- Health care service plans regulated by the Department of Managed Health Care
- Health insurers regulated by the Department of Insurance
Limits and Unknowns
- The bill does not specify an effective date.
- The official text states no state reimbursement is required for a specified reason, but it does not detail what that reason is.