California Insurance Code

§ 10133.52

INS § 10133.52 Effective Jan 1, 2026Div. 2 · Part 2 · Ch. 1 · Art. 2

Statute text

(a)On or before July 1, 2026, the department shall issue instructions to health insurers to report all covered health care services subject to prior authorization, the percentage rate at which they are approved or modified by the health insurer 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 insurer 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 insurer 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 insurer delegates responsibility for decisions regarding prior authorization requests to another entity, the health insurer shall obtain information required to be reported by this section from each delegated entity and include that information in the health insurer’s report to the department. A health insurer 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. 2. (SB 306) Effective January 1, 2026. Repealed as of January 1, 2034, by its own provisions.