California AB 510: Local government records: destruction of records.
Status: From committee: Filed with the Chief Clerk pursuant to Joint Rule 56. (as of 2020-02-03)
State: California · Session: 20192020 · Bill: AB 510
Subjects: Local government records: destruction of records.
Sponsors: Cooley
Bill Text
• • • • • • Bill Text - AB-510 Health care coverage: utilization review: peer-to-peer review. • • skip to content • home • accessibility • FAQ • feedback • sitemap • login • x Quick Search: Bill Number Bill Keyword • • • • • • Home • Bill Information • California Law • Publications • Other Resources • My Subscriptions • My Favorites • Bill Information >> • Bill Search >> • Text Bill Text PDF2 Bill PDF |Add To My Favorites |Track Bill | Version: 04/28/25 - Amended Assembly 04/10/25 - Amended Assembly 02/10/25 - Introduced AB-510 Health care coverage: utilization review: peer-to-peer review.(2025-2026) Text >> Votes >> History >> Bill Analysis >> Today's Law As Amended >> Compare Versions >> Status >> Comments To Author >> Track Bill >> Add To My Favorites >> SHARE THIS: Date Published: 04/28/2025 02:00 PM AB510:v97#DOCUMENTBill Start Amended IN Assembly April 28, 2025 Amended IN Assembly April 10, 2025 CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION Assembly Bill No. 510 Introduced by Assembly Member Addis February 10, 2025 An act to amend Section 1368.01 of, and to add Section 1367.017 to, to the Health and Safety Code, to amend Section 10123.137 of, and to add Section 10123.138 to, to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGEST AB 510, as amended, Addis. Health care coverage: utilization review: appeals and grievances. peer-to-peer review. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of disability insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or disability insurer to use prior authorization and other utilization review or utilization management functions, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law requires a health care service plan or disability insurer to include in a response regarding decisions to deny, delay, or modify health care services, among other things, information on how the provider, enrollee, or insured may file a grievance or appeal with the plan or insurer. Existing law requires a health care service plan’s grievance system to resolve grievances within 30 days, except as specified. Existing law requires a contract between a health insurer and a provider to contain provisions requiring a dispute resolution mechanism, and requires an insurer to resolve each provider dispute within 45 working days, as specified. This bill would, upon request, require that an appeal or grievance regarding bill, upon communication of a decision by a health care service plan or health insurer delaying, denying, or modifying a health care service based in whole or in part on medical necessity, be reviewed by would authorize a provider to request review of the decision by a licensed physician, or a licensed health care professional under specified circumstances, who is competent to evaluate the specific clinical issues involved in the health care service being requested, and is of the same or similar specialty as the requesting provider. The bill would authorize review of a grievance or appeal by a licensed health care professional to be the reviewer if the provider requesting peer-to-peer review is not a physician. The bill, notwithstanding the above-described timelines, any other law, would require these reviews to occur within 2 business days, or if an enrollee or insured faces an imminent and serious threat to their health, within a timely fashion appropriate for the nature of the enrollee’s or insured’s condition, as specified. If a health care service plan or health insurer fails to meet those timelines, the bill would deem the request for the health care service as approved and supersede any prior delay, denial, or modification. The bill would make conforming changes to related provisions. Because a violation of these provisions by a health care service plan would be a crime, this bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill Text The people of the State of California do enact as follows: SECTION 1. Section 1367.017 is added to the Health and Safety Code, to r
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