California Health and Safety Code

§ 1367.025

HSC § 1367.025 Effective Jan 1, 2026Div. 2 · Ch. 2.2 · Art. 5

Statute text

(a)On or before July 1, 2026, the department shall issue instructions to health care service plans to report all covered health care services subject to prior authorization, the percentage rate at which they are approved or modified by the health care service plan or its delegated entity, and other statistics regarding prior authorization determinations as determined by the department. These instructions shall include a standard reporting template.

(b)(1) On or before December 31, 2026, a health care service plan shall report to the department, in accordance with the instructions issued pursuant to subdivision (a), the covered health care services subject to prior authorization, the percentage rate at which they are approved or modified by the health care service plan or its delegated entity, data regarding requested or authorized duration, frequency, or level of care of the health care services, and other statistics regarding prior authorization determinations pursuant to subdivision (a). Data regarding modifications shall be reported separately from approvals in accordance with the instructions issued pursuant to subdivision (a).

(2)If a health care service plan delegates responsibility for decisions regarding prior authorization requests to another entity, the health care service plan shall obtain information required to be reported by this section from each delegated entity and include that information in the health care service plan’s report to the department. A health care service plan shall require a delegated entity to comply with a request made pursuant to this paragraph.

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Legislative history

Added by Stats. 2025, Ch. 408, Sec. 1. (SB 306) Effective January 1, 2026. Repealed as of January 1, 2034, by its own provisions.