California Health and Safety Code
§ 1367.253
HSC § 1367.253 Effective Jun 29, 2026Div. 2 · Ch. 2.2 · Art. 5
Statute text
View on leginfo.ca.gov(a)A health care service plan shall base a medical necessity determination or the utilization review criteria that the plan, and an entity acting on the plan’s behalf, applies to determine the medical necessity of health care services and benefits for the treatment of symptoms resulting from menopause on current generally accepted standards of menopause care.
(b)Beginning January 1, 2027, when conducting utilization review of all covered health care services and benefits for the treatment of symptoms resulting from menopause, a health care service plan shall apply criteria and guidelines developed by the Menopause Society or another nationally recognized professional association, as specified by the department.
(c)In conducting utilization review involving patient care decisions that are within the scope of the sources specified in subdivision (b), a health care service plan shall not apply different, additional, conflicting, or more restrictive utilization review criteria than the criteria and guidelines set forth in those sources. This subdivision does not prohibit a plan from applying utilization review criteria to health care services and benefits for menopause care that meet either of the following criteria:
…
Legislative history
Added by Stats. 2026, Ch. 27, Sec. 14. (SB 164) Effective June 29, 2026.