California 20252026 Regular Session Status: Introduced 1 D cosponsors

AB 2431 — Downcoding medical claims.

Last action — In committee: Held under submission.

  1. 1
    Introduced
  2. 2
    In Committee
  3. 3
    Passed Assembly
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill has been introduced in the Assembly. Introduced February 20, 2026. It must pass committee before a floor vote.

Next likely step: a committee referral and hearing.

Odds of enactment

Low chance

Based on the sponsor, cosponsors, and committee posture, this bill has a low chance of becoming law.

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A statistical estimate from our own model of past outcomes — an insight, not a guarantee. Policymaking is volatile.

Prognosis

Stalled 28% · moderate confidence

  • Introduced

    Current position in the legislative process.

  • 1 sponsor

    1 primary, 0 co-sponsors signed on.

  • Single-party support

    Sponsorship is currently within one party (1 D).

  • Cleared a recorded vote

    Passed 1 recorded vote so far.

Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.

Summary

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 health insurers by the Department of Insurance. Existing law sets forth requirements by which a health care service plan or health insurer reimburses a provider for health care services. This bill would require a determination to downcode a claim, which is the unilateral alteration by a payer of the service or procedure code submitted on a claim resulting in a lower payment, to include a documented review of the clinical information supporting the billed service. The bill would set forth requirements for and limitations of downcoding decisions, and, if a claim is downcoded, would require a plan or insurer to provide a billing provider with specified information and a clear and accessible process for disputing downcoded claims. The bill would prohibit a plan or insurer from using downcoding practices in a targeted or discriminatory manner against physicians or other health care providers who routinely treat patients with high acuity, complex, or chronic conditions, and would authorize the departments to take action against a plan or insurer that engages in a pattern or practice of discriminatory downcoding or that otherwise violates these provisions. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. The bill would require the departments to collect data on coding and claims adjustment practices, evaluate the information, and submit a report with specified information to the Legislature. 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.

Bill Text

Action History

  1. In committee: Held under submission.

  2. In committee: Set, first hearing. Referred to APPR. suspense file.

  3. Re-referred to Com. on APPR. pursuant to Assembly Rule 96.

  4. Re-referred to Com. on P. & C.P.

  5. Read second time and amended.

  6. From committee: Amend, and do pass as amended and re-refer to Com. on P. & C.P. (Ayes 16. Noes 0.) (April 7).

  7. Referred to Coms. on HEALTH and P. & C.P.

  8. From printer. May be heard in committee March 23.

  9. Read first time. To print.

Sponsors

Sponsorship breakdown

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1 sponsors · 0 co-sponsors · 121 not signed on

Sponsors (1)

Co-sponsors (0)

None.

Not signed on (121)

121 members have not signed on to this bill.

Show all 121 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Do pass as amended and be re-referred to the Committee on [Privacy and Consumer Protection]

Passed 16 Yea · 0 Nay
Party YeaNayPresentNot Voting
Democratic 12000
Republican 4000
Total 16000
% of votes cast 100%0%0%0%
How each member voted (16)
Member Party Vote
Addis, Dawn Democratic Yea
Aguiar-Curry, Cecilia M. Democratic Yea
Ahrens, Patrick Democratic Yea
Bonta, Mia Democratic Yea
Caloza, Jessica Democratic Yea
Carrillo, Juan Democratic Yea
González, Mark Democratic Yea
Patel, Darshana R. Democratic Yea
Rogers, Chris Democratic Yea
Schiavo, Pilar Democratic Yea
Sharp-Collins, LaShae Democratic Yea
Stefani, Catherine Democratic Yea
Chen, Phillip Republican Yea
Johnson, Natasha Republican Yea
Patterson, Joe Republican Yea
Sanchez, Kate Republican Yea

Official roll call →

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does AB 2431 do?
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 health insurers by the Department of Insurance. Existing law sets forth requirements by which a health care service plan or health insurer reimburses a provider for health care services. This bill would require a determination to downcode a claim, which is the unilateral alteration by a payer of the service or procedure code submitted on a claim resulting in a lower payment, to include a documented review of the clinical information supporting the billed service. The bill would set forth requirements for and limitations of downcoding decisions, and, if a claim is downcoded, would require a plan or insurer to provide a billing provider with specified information and a clear and accessible process for disputing downcoded claims. The bill would prohibit a plan or insurer from using downcoding practices in a targeted or discriminatory manner against physicians or other health care providers who routinely treat patients with high acuity, complex, or chronic conditions, and would authorize the departments to take action against a plan or insurer that engages in a pattern or practice of discriminatory downcoding or that otherwise violates these provisions. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. The bill would require the departments to collect data on coding and claims adjustment practices, evaluate the information, and submit a report with specified information to the Legislature. 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.
Who sponsors AB 2431?
AB 2431 is sponsored by Patel, Darshana R. (Democratic).
What is the current status of AB 2431?
This bill has been introduced in the Assembly. Introduced February 20, 2026. It must pass committee before a floor vote.
Where can I track AB 2431?
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Last checked for changes 3 months ago · updated continuously

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