California 2015-2016 Regular Session Status: Enacted

SB 282 — Health care coverage: prescription drugs.

Last action — Chaptered by Secretary of State. Chapter 654, Statutes of 2015.

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

This bill has been enacted into law. Introduced February 19, 2015. Enacted.

Prognosis

Likely to advance 70% · moderate confidence

Where this bill stands today.

Odds of enactment

High

How often bills like it became law.

  • Enacted

    Current position in the legislative process.

  • 1 sponsor

    1 primary, 0 co-sponsors signed on.

  • Cleared a recorded vote

    Passed 8 recorded votes so far.

Prognosis reads this bill's own signals — stage, sponsorship breadth, committee status, recorded votes and cross-state momentum. Odds come from a model trained on which bills have become law.

Summary

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the 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. Commonly referred to as utilization review, existing law governs the procedures that apply to every health care service plan and health insurer that prospectively, retrospectively, or concurrently reviews and approves, modifies, delays, or denies, based on medical necessity, requests by providers prior to, retrospectively, or concurrent with, the provision of health care services to enrollees or insureds, as specified. Existing law requires the Department of Managed Health Care and the Department of Insurance to jointly develop a uniform prior authorization form for prescription drug benefits on or before July 1, 2012, and requires, 6 months after the form is developed, every prescribing provider, when requesting prior authorization for prescription drug benefits, to submit the request to the health care service plan or health insurer using the uniform form, and requires those plans and insurers to accept only the uniform form. Existing law authorizes a prescribing provider to submit the prior authorization form electronically to the plan or insurer, and, if the plan or insurer fails to respond to a request within 2 business days, the request is deemed granted. Existing law also requires health care service plans to maintain a process by which prescribing providers may obtain authorization for a medically necessary nonformulary prescription drug. This bill would authorize the prescribing provider to additionally use an electronic process developed specifically for transmitting prior authorization information that meets the National Council for Prescription Drug Programs' SCRIPT standard for electronic prior authorization transactions. The bill would require the departments to develop the uniform prior authorization form on or before January 1, 2017, and would require prescribing providers to use, and health care service plans and health insurers to accept, only those forms or electronic process on and after July 1, 2017, or 6 months after the form is developed, whichever is later. This bill would deem a prior authorization request to be granted if the plan or insurer fails to respond within 72 hours for nonurgent requests, and within 24 hours when exigent circumstances exist. This bill would specify that the provisions described above relating to prior authorization for prescription drugs do not apply if a contracted physician group is delegated the financial risk for the prescription drugs by a health care service plan or health insurer, if a contracted physician group uses its own internal prior authorization process rather than the health care service plan's or the health insurer's prior authorization process for its enrollees or insureds, or if a contracted physician group is delegated a utilization management function by the health care service plan or the health insurer concerning any prescription drug, regardless of the delegation of financial risk. Existing law requires health care service plans to establish a grievance process approved by the Department of Managed Health Care. This bill would require, subject to exceptions, the grievance process established by a health care service plan or a health insurer to comply with specified federal regulations. Because a willful violation of the bill's requirements relative to health care service plans 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.

Bill Text

Action History

  1. Chaptered by Secretary of State. Chapter 654, Statutes of 2015.

  2. Approved by the Governor.

  3. Enrolled and presented to the Governor at 5 p.m.

  4. Assembly amendments concurred in. (Ayes 40. Noes 0. Page 2564.) Ordered to engrossing and enrolling.

  5. In Senate. Concurrence in Assembly amendments pending.

  6. Read third time. Passed. (Ayes 78. Noes 0. Page 2924.) Ordered to the Senate.

  7. Ordered to third reading.

  8. Read third time and amended.

  9. Read second time. Ordered to third reading.

  10. From committee: Do pass. (Ayes 17. Noes 0.) (August 27).

  11. August 19 set for first hearing. Placed on APPR. suspense file.

  12. From committee: Do pass and re-refer to Com. on APPR. with recommendation: To consent calendar. (Ayes 19. Noes 0.) (July 14). Re-referred to Com. on APPR.

  13. From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.

  14. July 7 hearing postponed by committee.

  15. June 30 set for second hearing canceled at the request of author.

  16. June 23 set for first hearing canceled at the request of author.

  17. From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.

  18. Referred to Com. on HEALTH.

  19. In Assembly. Read first time. Held at Desk.

  20. Read third time. Passed. (Ayes 40. Noes 0. Page 1199.) Ordered to the Assembly.

  21. Read second time. Ordered to third reading.

  22. From committee: Do pass. (Ayes 7. Noes 0. Page 1150.) (May 28).

  23. Set for hearing May 28.

  24. May 4 hearing: Placed on APPR. suspense file.

  25. Set for hearing May 4.

  26. From committee: Do pass and re-refer to Com. on APPR. (Ayes 8. Noes 0. Page 758.) (April 22). Re-referred to Com. on APPR.

  27. Set for hearing April 22.

  28. From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.

  29. Referred to Com. on HEALTH.

  30. From printer. May be acted upon on or after March 22.

  31. Introduced. Read first time. To Com. on RLS. for assignment. To print.

Sponsors

  • Hernandez · Primary

Sponsorship breakdown

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

Sponsors (1)

  • Hernandez

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

Unfinished Business SB282 Hernandez Concurrence

Passed 40 Yea · 0 Nay
Party YeaNayPresentNot Voting
Unaffiliated 37000
Democratic 3000
Total 40000
% of votes cast 100%0%0%0%
How each member voted (40)
Member Party Vote
Anderson — Yea
Block — Yea
Hernandez — Yea
Lara — Yea
Liu — Yea
Wieckowski — Yea
Allen — Yea
Mitchell — Yea
De León — Yea
Runner — Yea
Galgiani — Yea
Cannella — Yea
Glazer — Yea
Hall — Yea
Hancock — Yea
Bates — Yea
Beall — Yea
Hertzberg — Yea
Hill — Yea
Hueso — Yea
Huff — Yea
Leno — Yea
Leyva — Yea
Mendoza — Yea
Monning — Yea
Moorlach — Yea
Morrell — Yea
Nielsen — Yea
Pan — Yea
Pavley — Yea
Roth — Yea
Vidak — Yea
Wolk — Yea
Fuller — Yea
Beth Gaines — Yea
Bill Berryhill — Yea
Mark Stone — Yea
Jackson, Corey A. Democratic Yea
McGuire, Mike Democratic Yea
Nguyen, Stephanie Democratic Yea

Official roll call →

SB 282 Hernandez Senate Third Reading By SANTIAGO

Passed 78 Yea · 0 Nay · 2 Other
Party YeaNayPresentNot Voting
Unaffiliated 69002
Democratic 4000
Republican 5000
Total 78002
% of votes cast 98%0%0%3%
How each member voted (80)
Member Party Vote
Achadjian — Yea
Baker — Yea
Bloom — Yea
Brough — Yea
Brown — Yea
Jones-Sawyer — Not Voting
Levine — Yea
Maienschein — Yea
Mathis — Yea
O'Donnell — Yea
Perea — Yea
Ridley-Thomas — Not Voting
Steinorth — Yea
Wagner — Yea
Wilk — Yea
Eggman — Yea
Daly — Yea
Cooper — Yea
Salas — Yea
Mayes — Yea
Olsen — Yea
Frazier — Yea
Gatto — Yea
Burke — Yea
Gordon — Yea
Harper — Yea
Holden — Yea
Campos — Yea
Kim — Yea
Linder — Yea
Low — Yea
Gray — Yea
McCarty — Yea
Medina — Yea
Atkins — Yea
Chang — Yea
Bonilla — Yea
Melendez — Yea
Lopez — Yea
Mullin — Yea
Alejo — Yea
Bigelow — Yea
Chau — Yea
Chiu — Yea
Chu — Yea
Chávez — Yea
Cooley — Yea
Dababneh — Yea
Dodd — Yea
Nazarian — Yea
Obernolte — Yea
Quirk — Yea
Rendon — Yea
Rodriguez — Yea
Santiago — Yea
Thurmond — Yea
Ting — Yea
Waldron — Yea
Weber — Yea
Williams — Yea
Wood — Yea
Gomez — Yea
Hadley — Yea
Beth Gaines — Yea
Cristina Garcia — Yea
Eduardo Garcia — Yea
Jim Patterson — Yea
Lorena Gonzalez — Yea
Mark Stone — Yea
Roger Hernández — Yea
Travis Allen — Yea
Bonta, Mia Democratic Yea
Calderon, Lisa Democratic Yea
Gipson, Mike A. Democratic Yea
Irwin, Jacqui Democratic Yea
Dahle, Megan Republican Yea
Gallagher, James Republican Yea
Grove, Shannon Republican Yea
Jones, Brian W. Republican Yea
Lackey, Tom Republican Yea

Official roll call →

Do pass.

Passed 17 Yea · 0 Nay
Party YeaNayPresentNot Voting
Unaffiliated 13000
Democratic 2000
Republican 2000
Total 17000
% of votes cast 100%0%0%0%
How each member voted (17)
Member Party Vote
Bloom — Yea
Wagner — Yea
Eggman — Yea
Chang — Yea
Gomez — Yea
Holden — Yea
Bigelow — Yea
Nazarian — Yea
Quirk — Yea
Rendon — Yea
Weber — Yea
Wood — Yea
Eduardo Garcia — Yea
Bonta, Mia Democratic Yea
Calderon, Lisa Democratic Yea
Gallagher, James Republican Yea
Jones, Brian W. Republican Yea

Official roll call →

Do pass and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar

Passed 19 Yea · 0 Nay
Party YeaNayPresentNot Voting
Democratic 1000
Unaffiliated 16000
Republican 2000
Total 19000
% of votes cast 100%0%0%0%
How each member voted (19)
Member Party Vote
Maienschein — Yea
Chávez — Yea
Bonilla — Yea
Burke — Yea
Chiu — Yea
Nazarian — Yea
Ridley-Thomas — Yea
Rodriguez — Yea
Santiago — Yea
Steinorth — Yea
Thurmond — Yea
Waldron — Yea
Wood — Yea
Gomez — Yea
Gonzalez — Yea
Roger Hernández — Yea
Bonta, Mia Democratic Yea
Lackey, Tom Republican Yea
Patterson, Joe Republican Yea

Official roll call →

3rd Reading

Passed 40 Yea · 0 Nay
Party YeaNayPresentNot Voting
Unaffiliated 37000
Democratic 3000
Total 40000
% of votes cast 100%0%0%0%
How each member voted (40)
Member Party Vote
Anderson — Yea
Block — Yea
Hancock — Yea
Leno — Yea
Leyva — Yea
Pavley — Yea
Roth — Yea
Vidak — Yea
Wolk — Yea
Fuller — Yea
Galgiani — Yea
Cannella — Yea
Allen — Yea
Glazer — Yea
Mitchell — Yea
De León — Yea
Runner — Yea
Hernandez — Yea
Hertzberg — Yea
Bates — Yea
Beall — Yea
Hill — Yea
Hueso — Yea
Huff — Yea
Lara — Yea
Liu — Yea
Mendoza — Yea
Monning — Yea
Moorlach — Yea
Morrell — Yea
Nielsen — Yea
Pan — Yea
Wieckowski — Yea
Hall — Yea
Beth Gaines — Yea
Bill Berryhill — Yea
Mark Stone — Yea
Jackson, Corey A. Democratic Yea
McGuire, Mike Democratic Yea
Nguyen, Stephanie Democratic Yea

Official roll call →

Do pass

Passed 7 Yea · 0 Nay
Party YeaNayPresentNot Voting
Unaffiliated 7000
Total 7000
% of votes cast 100%0%0%0%
How each member voted (7)
Member Party Vote
Lara — Yea
Leyva — Yea
Hill — Yea
Bates — Yea
Beall — Yea
Mendoza — Yea
Nielsen — Yea

Official roll call →

Placed on suspense file

Passed 7 Yea · 0 Nay
Party YeaNayPresentNot Voting
Unaffiliated 7000
Total 7000
% of votes cast 100%0%0%0%
How each member voted (7)
Member Party Vote
Bates — Yea
Lara — Yea
Mendoza — Yea
Nielsen — Yea
Hill — Yea
Beall — Yea
Leyva — Yea

Official roll call →

Subjects

healthcare health-insurance
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Frequently asked questions

What does SB 282 do?
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the 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. Commonly referred to as utilization review, existing law governs the procedures that apply to every health care service plan and health insurer that prospectively, retrospectively, or concurrently reviews and approves, modifies, delays, or denies, based on medical necessity, requests by providers prior to, retrospectively, or concurrent with, the provision of health care services to enrollees or insureds, as specified. Existing law requires the Department of Managed Health Care and the Department of Insurance to jointly develop a uniform prior authorization form for prescription drug benefits on or before July 1, 2012, and requires, 6 months after the form is developed, every prescribing provider, when requesting prior authorization for prescription drug benefits, to submit the request to the health care service plan or health insurer using the uniform form, and requires those plans and insurers to accept only the uniform form. Existing law authorizes a prescribing provider to submit the prior authorization form electronically to the plan or insurer, and, if the plan or insurer fails to respond to a request within 2 business days, the request is deemed granted. Existing law also requires health care service plans to maintain a process by which prescribing providers may obtain authorization for a medically necessary nonformulary prescription drug. This bill would authorize the prescribing provider to additionally use an electronic process developed specifically for transmitting prior authorization information that meets the National Council for Prescription Drug Programs' SCRIPT standard for electronic prior authorization transactions. The bill would require the departments to develop the uniform prior authorization form on or before January 1, 2017, and would require prescribing providers to use, and health care service plans and health insurers to accept, only those forms or electronic process on and after July 1, 2017, or 6 months after the form is developed, whichever is later. This bill would deem a prior authorization request to be granted if the plan or insurer fails to respond within 72 hours for nonurgent requests, and within 24 hours when exigent circumstances exist. This bill would specify that the provisions described above relating to prior authorization for prescription drugs do not apply if a contracted physician group is delegated the financial risk for the prescription drugs by a health care service plan or health insurer, if a contracted physician group uses its own internal prior authorization process rather than the health care service plan's or the health insurer's prior authorization process for its enrollees or insureds, or if a contracted physician group is delegated a utilization management function by the health care service plan or the health insurer concerning any prescription drug, regardless of the delegation of financial risk. Existing law requires health care service plans to establish a grievance process approved by the Department of Managed Health Care. This bill would require, subject to exceptions, the grievance process established by a health care service plan or a health insurer to comply with specified federal regulations. Because a willful violation of the bill's requirements relative to health care service plans 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.
Who sponsors SB 282?
SB 282 is sponsored by Hernandez.
What is the current status of SB 282?
This bill has been enacted into law. Introduced February 19, 2015. Enacted.
Where can I track SB 282?
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