Bill Text: CA SB1033 | 2019-2020 | Regular Session | Introduced


Bill Title: Health care coverage: utilization review criteria.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2020-02-27 - Referred to Com. on HEALTH. [SB1033 Detail]

Download: California-2019-SB1033-Introduced.html


CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill
No. 1033


Introduced by Senator Pan

February 14, 2020


An act to add Section 1363.6 to the Health and Safety Code, and to add Section 10123.136 to the Insurance Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


SB 1033, as introduced, Pan. Health care coverage: utilization review criteria.
Existing law provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer to establish criteria or guidelines that meet specified requirements to be used to determine whether or not to authorize, modify, or deny health care services.
This bill would authorize the Department of Managed Health Care and the Insurance Commissioner, as appropriate, to review a plan’s or insurer’s clinical criteria, guidelines, and utilization management policies to ensure compliance with existing law. If the criteria and guidelines are not in compliance with existing law, the bill would authorize the Director of the Department of Managed Health Care or the commissioner to issue a corrective action and send the matter to enforcement, if necessary.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1363.6 is added to the Health and Safety Code, to read:

1363.6.
 The department may review a plan’s clinical criteria, guidelines, and utilization management policies established pursuant to Section 1363.5, 1367.01, or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the director shall issue a corrective action and, if necessary, send the matter to enforcement.

SEC. 2.

 Section 10123.136 is added to the Insurance Code, to read:

10123.136.
 The commissioner may review an insurer’s clinical criteria, guidelines, and utilization management policies established pursuant to Section 10123.135 or any other provision of this chapter to ensure compliance with this chapter. Upon a finding that the criteria and guidelines are not in compliance with this chapter, the commissioner shall issue a corrective action and, if necessary, send the matter to enforcement.

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