California 2023-2024 Regular Session Status: Passed Senate 4 D cosponsors

SB 516 — Health care coverage: prior authorization.

Last action — August 27 set for first hearing canceled at the request of author.

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

This bill died with 2023-2024 Regular Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

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 generally authorizes a health care service plan or health 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 health insurer, including those plans or insurers that delegate utilization review or utilization management functions to medical groups, independent practice associations, or to other contracting providers, to comply with specified requirements and limitations on their utilization review or utilization management functions. Existing law requires the criteria or guidelines used to determine whether or not to authorize, modify, or deny health care services to be developed with involvement from actively practicing health care providers. This bill would require the Department of Managed Health Care and the Department of Insurance, by July 1, 2025, to issue instructions to health care service plans and health insurers to report specified information relating to prior authorization, as defined, including designated health care services (services) , items, and supplies subject to prior authorization and the percentage rate at which health care service plans, health insurers, or their delegated entities, approve or modify those services, items, and supplies. The bill would require health care service plans and health insurers to report that information to the relevant department by December 31, 2025, or as otherwise specified. The bill would require the relevant department to evaluate the reports received from the health care service plans and health insurers, and identify the services, items, and supplies most frequently approved by the plans or insurers or their delegated entities, as specified. The bill would require each department, after evaluating the reports received from health care service plans and health insurers, to identify, and by December 31, 2026, to publish a list of, the most frequently approved or modified services, items, and supplies, based on a prescribed threshold percentage rate. The bill would authorize the department to consider certain factors when determining the appropriateness of removing prior authorization for a specific health care service, item, or supply, regardless of its approval percentage rate. The bill would require the department to issue instructions to health care service plans and health insurers regarding, among other matters, the date by which the listed services, items, and supplies would no longer be subject to prior authorization, and how a plan or insurer could reinstate prior authorization upon a showing of good cause, as prescribed. Within 4 years from the cessation date of the prior authorization requirements, the bill would require each department to publish a report regarding the impact of the cessation of those requirements. The bill would authorize the departments to contract with a consultant with expertise in prior authorization procedures to assist with implementation of the bill, as specified. The bill would provide that it would not apply with respect to specified types of health care service plans including, but not limited to, specialized health care service plans, or to specialized health insurers, except as specified. The provisions would be repealed on January 1, 2032. Because a willful violation of the bill's requirements relative to health care service plans would be a crime, the 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. August 27 set for first hearing canceled at the request of author.

  2. Re-referred to Com. on HEALTH pursuant to Assembly Rule 77.2.

  3. Ordered to third reading.

  4. Read third time and amended.

  5. Read second time. Ordered to third reading.

  6. Read second time and amended. Ordered to second reading.

  7. From committee: Do pass as amended. (Ayes 12. Noes 0.) (August 15).

  8. August 7 set for first hearing. Placed on suspense file.

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

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

  11. Re-referred to Com. on RLS.

  12. Ordered to third reading.

  13. From inactive file.

  14. Notice of intention to remove from inactive file given by Assembly Member Bonta.

  15. Ordered to inactive file on request of Assembly Member Bonta.

  16. Action rescinded whereby bill was re-referred to Com. on JUD. pursuant to Assembly Rule 77.2.

  17. Action rescinded whereby bill was read third time and amended.

  18. Re-referred to Com. on JUD. pursuant to Assembly Rule 77.2.

  19. Ordered to third reading.

  20. Read third time and amended. (Ayes 60. Noes 15. Page 3013.)

  21. Read second time. Ordered to third reading.

  22. Read second time and amended. Ordered to second reading.

  23. From committee: Do pass as amended. (Ayes 12. Noes 2.) (September 1).

  24. August 23 set for first hearing. Placed on suspense file.

  25. Read second time and amended. Re-referred to Com. on APPR.

  26. From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 8. Noes 0.) (June 26).

  27. Referred to Com. on REV. & TAX.

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

  29. Read third time. Passed. (Ayes 32. Noes 8. Page 1268.) Ordered to the Assembly.

  30. Read second time. Ordered to third reading.

  31. Read second time and amended. Ordered to second reading.

  32. From committee: Do pass as amended. (Ayes 5. Noes 2. Page 1173.) (May 18).

  33. Set for hearing May 18.

  34. May 8 hearing: Placed on APPR suspense file.

  35. Set for hearing May 8.

  36. Read second time and amended. Re-referred to Com. on APPR.

  37. From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 4. Noes 1. Page 901.) (April 25).

  38. From committee: Do pass and re-refer to Com. on PUB S. (Ayes 6. Noes 2. Page 795.) (April 19). Re-referred to Com. on PUB S.

  39. Set for hearing April 25 in PUB S. pending receipt.

  40. From committee with author's amendments. Read second time and amended. Re-referred to Com. on GOV. & F.

  41. Set for hearing April 19.

  42. Referred to Coms. on GOV. & F. and PUB S.

  43. From printer. May be acted upon on or after March 17.

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

Sponsors

Sponsorship breakdown

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1 sponsors · 4 co-sponsors · 117 not signed on · 19 voted No

Sponsors (1)

  • Skinner

Co-sponsors (4)

Not signed on (117)

117 members have not signed on to this bill.

Show all 117 →

"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.

Passed 12 Yea · 0 Nay · 3 Other
Party YeaNayPresentNot Voting
Democratic 9000
Unaffiliated 2001
Republican 1002
Total 12003
% of votes cast 80%0%0%20%
How each member voted (15)
Member Party Vote
Villapudua — Yea
Jim Patterson — Not Voting
Wendy Carrillo — Yea
Arambula, Joaquin Democratic Yea
Bryan, Isaac G. Democratic Yea
Calderon, Lisa Democratic Yea
Fong, Mike Democratic Yea
Grayson, Timothy S. Democratic Yea
Haney, Matt Democratic Yea
Hart, Gregg Democratic Yea
Pellerin, Gail Democratic Yea
Wicks, Buffy Democratic Yea
Dixon, Diane Republican Yea
Sanchez, Kate Republican Not Voting
Ta, Tri Republican Not Voting

Official roll call →

SB 516 Skinner Senate Third Reading By Bonta Amend By BONTA Set #1

Passed 60 Yea · 15 Nay · 5 Other
Party YeaNayPresentNot Voting
Democratic 43004
Unaffiliated 15401
Republican 21100
Total 601505
% of votes cast 75%19%0%6%
How each member voted (80)
Member Party Vote
Holden — Yea
Maienschein — Yea
Rodriguez — Yea
Villapudua — Yea
Ting — Yea
Jones-Sawyer — Yea
McCarty — Yea
Rendon — Yea
Friedman — Yea
Low — Yea
Wood — Yea
Santiago — Yea
Waldron — Nay
Mathis — Nay
Essayli — Not Voting
Eduardo Garcia — Yea
Jim Patterson — Nay
Luz Rivas — Yea
Vince Fong — Nay
Wendy Carrillo — Yea
Addis, Dawn Democratic Yea
Aguiar-Curry, Cecilia M. Democratic Yea
Alvarez, David Democratic Yea
Arambula, Joaquin Democratic Yea
Bains, Jasmeet Democratic Not Voting
Bauer-Kahan, Rebecca Democratic Yea
Bennett, Steve Democratic Yea
Berman, Marc Democratic Yea
Boerner, Tasha Democratic Yea
Bonta, Mia Democratic Yea
Bryan, Isaac G. Democratic Yea
Calderon, Lisa Democratic Yea
Carrillo, Juan Democratic Yea
Cervantes, Sabrina Democratic Yea
Connolly, Damon Democratic Yea
Fong, Mike Democratic Yea
Gabriel, Jesse Democratic Yea
Gipson, Mike A. Democratic Yea
Grayson, Timothy S. Democratic Yea
Haney, Matt Democratic Yea
Hart, Gregg Democratic Yea
Irwin, Jacqui Democratic Yea
Jackson, Corey A. Democratic Yea
Kalra, Ash Democratic Yea
Lee, Alex Democratic Yea
Lowenthal, Josh Democratic Yea
McKinnor, Tina Democratic Yea
Muratsuchi, Al Democratic Yea
Nguyen, Stephanie Democratic Yea
Ortega, Liz Democratic Yea
Pacheco, Blanca Democratic Not Voting
Papan, Diane Democratic Not Voting
Pellerin, Gail Democratic Yea
Petrie-Norris, Cottie Democratic Yea
Quirk-Silva, Sharon Democratic Yea
Ramos, James C. Democratic Yea
Reyes, Eloise Gómez Democratic Yea
Rivas, Robert Democratic Yea
Rubio, Blanca E. Democratic Yea
Schiavo, Pilar Democratic Not Voting
Soria, Esmeralda Democratic Yea
Valencia, Avelino Democratic Yea
Ward, Christopher M. Democratic Yea
Weber Pierson, M.D., Akilah Democratic Yea
Wicks, Buffy Democratic Yea
Wilson, Lori D. Democratic Yea
Zbur, Rick Chavez Democratic Yea
Alanis, Juan Republican Yea
Chen, Phillip Republican Yea
Dahle, Megan Republican Nay
Davies, Laurie Republican Nay
Dixon, Diane Republican Nay
Flora, Heath Republican Nay
Gallagher, James Republican Nay
Hoover, Josh Republican Nay
Lackey, Tom Republican Nay
Patterson, Joe Republican Nay
Sanchez, Kate Republican Nay
Ta, Tri Republican Nay
Wallis, Greg Republican Nay

Official roll call →

Do pass as amended.

Passed 12 Yea · 2 Nay · 2 Other
Party YeaNayPresentNot Voting
Democratic 9001
Unaffiliated 3000
Republican 0201
Total 12202
% of votes cast 75%13%0%13%
How each member voted (16)
Member Party Vote
Holden — Yea
Mathis — Yea
Wendy Carrillo — Yea
Bryan, Isaac G. Democratic Yea
Calderon, Lisa Democratic Yea
Fong, Mike Democratic Yea
Hart, Gregg Democratic Yea
Lowenthal, Josh Democratic Yea
Papan, Diane Democratic Yea
Pellerin, Gail Democratic Yea
Soria, Esmeralda Democratic Not Voting
Weber Pierson, M.D., Akilah Democratic Yea
Wilson, Lori D. Democratic Yea
Dahle, Megan Republican Nay
Dixon, Diane Republican Nay
Sanchez, Kate Republican Not Voting

Official roll call →

Do pass as amended and be re-referred to the Committee on [Appropriations]

Passed 8 Yea · 0 Nay · 3 Other
Party YeaNayPresentNot Voting
Democratic 7000
Unaffiliated 1001
Republican 0002
Total 8003
% of votes cast 73%0%0%27%
How each member voted (11)
Member Party Vote
Jim Patterson — Not Voting
Luz Rivas — Yea
Bains, Jasmeet Democratic Yea
Calderon, Lisa Democratic Yea
Irwin, Jacqui Democratic Yea
Pacheco, Blanca Democratic Yea
Petrie-Norris, Cottie Democratic Yea
Valencia, Avelino Democratic Yea
Zbur, Rick Chavez Democratic Yea
Ta, Tri Republican Not Voting
Wallis, Greg Republican Not Voting

Official roll call →

3rd Reading

Passed 32 Yea · 8 Nay
Party YeaNayPresentNot Voting
Unaffiliated 10100
Democratic 21100
Republican 1600
Total 32800
% of votes cast 80%20%0%0%
How each member voted (40)
Member Party Vote
Roth — Yea
Atkins — Yea
Portantino — Yea
Newman — Yea
Min — Yea
Eggman — Yea
Glazer — Yea
Dodd — Yea
Bradford — Yea
Skinner — Yea
Wilk — Nay
Allen, Benjamin Democratic Yea
Archuleta, Bob Democratic Yea
Ashby, Angelique V. Democratic Yea
Becker, Josh Democratic Yea
Blakespear, Catherine S. Democratic Yea
Caballero, Anna M. Democratic Yea
Cortese, Dave Democratic Yea
Durazo, Maria Elena Democratic Yea
Gonzalez, Lena A. Democratic Yea
Hurtado, Melissa Democratic Yea
Laird, John Democratic Yea
Limón, Monique Democratic Yea
McGuire, Mike Democratic Yea
Menjivar, Caroline Democratic Yea
Nguyen, Stephanie Democratic Nay
Padilla, Stephen C. Democratic Yea
Rubio, Susan Democratic Yea
Smallwood-Cuevas, Lola Democratic Yea
Stern, Henry I. Democratic Yea
Umberg, Thomas J. Democratic Yea
Wahab, Aisha Democratic Yea
Wiener, Scott D. Democratic Yea
Alvarado-Gil, Marie Republican Nay
Dahle, Megan Republican Nay
Grove, Shannon Republican Nay
Jones, Brian W. Republican Nay
Niello, Roger W. Republican Yea
Ochoa Bogh, Rosilicie Republican Nay
Seyarto, Kelly Republican Nay

Official roll call →

Do pass, but first be re-referred to the Committee on [Public Safety]

Passed 6 Yea · 2 Nay
Party YeaNayPresentNot Voting
Democratic 4000
Unaffiliated 2000
Republican 0200
Total 6200
% of votes cast 75%25%0%0%
How each member voted (8)
Member Party Vote
Glazer — Yea
Skinner — Yea
Blakespear, Catherine S. Democratic Yea
Caballero, Anna M. Democratic Yea
Durazo, Maria Elena Democratic Yea
Wiener, Scott D. Democratic Yea
Dahle, Megan Republican Nay
Seyarto, Kelly Republican Nay

Official roll call →

Subjects

healthcare health-insurance
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Frequently asked questions

What does SB 516 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 generally authorizes a health care service plan or health 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 health insurer, including those plans or insurers that delegate utilization review or utilization management functions to medical groups, independent practice associations, or to other contracting providers, to comply with specified requirements and limitations on their utilization review or utilization management functions. Existing law requires the criteria or guidelines used to determine whether or not to authorize, modify, or deny health care services to be developed with involvement from actively practicing health care providers. This bill would require the Department of Managed Health Care and the Department of Insurance, by July 1, 2025, to issue instructions to health care service plans and health insurers to report specified information relating to prior authorization, as defined, including designated health care services (services) , items, and supplies subject to prior authorization and the percentage rate at which health care service plans, health insurers, or their delegated entities, approve or modify those services, items, and supplies. The bill would require health care service plans and health insurers to report that information to the relevant department by December 31, 2025, or as otherwise specified. The bill would require the relevant department to evaluate the reports received from the health care service plans and health insurers, and identify the services, items, and supplies most frequently approved by the plans or insurers or their delegated entities, as specified. The bill would require each department, after evaluating the reports received from health care service plans and health insurers, to identify, and by December 31, 2026, to publish a list of, the most frequently approved or modified services, items, and supplies, based on a prescribed threshold percentage rate. The bill would authorize the department to consider certain factors when determining the appropriateness of removing prior authorization for a specific health care service, item, or supply, regardless of its approval percentage rate. The bill would require the department to issue instructions to health care service plans and health insurers regarding, among other matters, the date by which the listed services, items, and supplies would no longer be subject to prior authorization, and how a plan or insurer could reinstate prior authorization upon a showing of good cause, as prescribed. Within 4 years from the cessation date of the prior authorization requirements, the bill would require each department to publish a report regarding the impact of the cessation of those requirements. The bill would authorize the departments to contract with a consultant with expertise in prior authorization procedures to assist with implementation of the bill, as specified. The bill would provide that it would not apply with respect to specified types of health care service plans including, but not limited to, specialized health care service plans, or to specialized health insurers, except as specified. The provisions would be repealed on January 1, 2032. Because a willful violation of the bill's requirements relative to health care service plans would be a crime, the 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 516?
SB 516 is sponsored by Skinner, Wiener, Scott D. (Democratic), Bains, Jasmeet (Democratic), Jackson, Corey A. (Democratic), and Weber Pierson, M.D., Akilah (Democratic).
What is the current status of SB 516?
This bill died with 2023-2024 Regular Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track SB 516?
Track SB 516 free on One Click Politics — get push/email alerts when it moves.

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