California 2023-2024 Regular Session Status: Passed Senate 2 D cosponsors

SB 238 — Health care coverage: independent medical review.

Last action — September 1 hearing: Held in committee and under submission.

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  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This bill is no longer active — its legislative session has ended, so there is no live prognosis.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 disability insurers by the Department of Insurance. Existing law establishes the Independent Medical Review System within each department, under which an enrollee or insured may seek review if a health care service has been denied, modified, or delayed by a health care service plan or disability insurer and the enrollee or insured has previously filed a grievance that remains unresolved after 30 days. This bill, commencing July 1, 2024, would require a health care service plan or a disability insurer that modifies, delays, or denies a health care service, based in whole or in part on medical necessity, to automatically submit within 24 hours a decision regarding a disputed health care service to the Independent Medical Review System, as well as the information that informed its decision, without requiring an enrollee or insured to submit a grievance, if the decision is to deny, modify, or delay specified services relating to mental health or substance use disorder conditions for an enrollee or insured up to 26 years of age. The bill would require a health care service plan or disability insurer, within 24 hours after submitting its decision to the Independent Medical Review System to provide notice to the appropriate department, the enrollee or insured or their representative, if any, and the enrollee's or insured's provider. The bill would require the notice to include notification to the enrollee or insured that they or their representative may cancel the independent medical review at any time before a determination, as specified. The bill would apply specified existing provisions relating to mental health and substance use disorders for purposes of its provisions, and would be subject to relevant provisions relating to the Independent Medical Review System that do not otherwise conflict with the express requirements of the bill. With respect to health care service plans, the bill would specify that its provisions do not apply to Medi-Cal managed care plan contracts. The bill would authorize the Insurance Commissioner to promulgate regulations subject to the Administrative Procedure Act to implement and enforce the bill, and to issue interim guidance, as specified. Because a willful violation of this provision by a health care service plan 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. September 1 hearing: Held in committee and under submission.

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

  3. August 16 hearing postponed by committee.

  4. From committee: Do pass and re-refer to Com. on APPR. (Ayes 12. Noes 3.) (June 27). Re-referred to Com. on APPR.

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

  6. Referred to Com. on HEALTH.

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

  8. Read third time. Passed. (Ayes 32. Noes 7. Page 1277.) Ordered to the Assembly.

  9. Read second time. Ordered to third reading.

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

  11. From committee: Do pass as amended. (Ayes 5. Noes 2. Page 1161.) (May 18).

  12. Set for hearing May 18.

  13. April 24 hearing: Placed on APPR suspense file.

  14. Set for hearing April 24.

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

  16. From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 9. Noes 0. Page 710.) (April 12).

  17. Set for hearing April 12.

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

  19. March 29 set for first hearing canceled at the request of author.

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

  21. Set for hearing March 29.

  22. Referred to Com. on HEALTH.

  23. From printer. May be acted upon on or after February 24.

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

Sponsors

Sponsorship breakdown

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1 sponsors · 3 co-sponsors · 118 not signed on · 9 voted No

Sponsors (1)

Co-sponsors (3)

Not signed on (118)

118 members have not signed on to this bill.

Show all 118 →

"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 and be re-referred to the Committee on [Appropriations]

Passed 12 Yea · 3 Nay
Party YeaNayPresentNot Voting
Unaffiliated 8100
Democratic 4000
Republican 0200
Total 12300
% of votes cast 80%20%0%0%
How each member voted (15)
Member Party Vote
McCarty — Yea
Wood — Yea
Villapudua — Yea
Santiago — Yea
Maienschein — Yea
Rodriguez — Yea
Waldron — Yea
Vince Fong — Nay
Wendy Carrillo — Yea
Aguiar-Curry, Cecilia M. Democratic Yea
Arambula, Joaquin Democratic Yea
Boerner, Tasha Democratic Yea
Weber Pierson, M.D., Akilah Democratic Yea
Flora, Heath Republican Nay
Patterson, Joe Republican Nay

Official roll call →

3rd Reading SB238 Wiener et al.

Passed 32 Yea · 7 Nay · 1 Other
Party YeaNayPresentNot Voting
Unaffiliated 10100
Democratic 21100
Republican 1501
Total 32701
% of votes cast 80%18%0%3%
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 Yea
Dahle, Megan Republican Nay
Grove, Shannon Republican Nay
Jones, Brian W. Republican Nay
Niello, Roger W. Republican Nay
Ochoa Bogh, Rosilicie Republican Not Voting
Seyarto, Kelly Republican Nay

Official roll call →

Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations]

Passed 9 Yea · 0 Nay · 3 Other
Party YeaNayPresentNot Voting
Unaffiliated 3000
Democratic 6002
Republican 0001
Total 9003
% of votes cast 75%0%0%25%
How each member voted (12)
Member Party Vote
Roth — Yea
Eggman — Yea
Glazer — Yea
Gonzalez, Lena A. Democratic Yea
Hurtado, Melissa Democratic Yea
Limón, Monique Democratic Yea
Menjivar, Caroline Democratic Yea
Nguyen, Stephanie Democratic Not Voting
Rubio, Susan Democratic Not Voting
Wahab, Aisha Democratic Yea
Wiener, Scott D. Democratic Yea
Grove, Shannon Republican Not Voting

Official roll call →

Subjects

healthcare health-insurance
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Frequently asked questions

What does SB 238 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 disability insurers by the Department of Insurance. Existing law establishes the Independent Medical Review System within each department, under which an enrollee or insured may seek review if a health care service has been denied, modified, or delayed by a health care service plan or disability insurer and the enrollee or insured has previously filed a grievance that remains unresolved after 30 days. This bill, commencing July 1, 2024, would require a health care service plan or a disability insurer that modifies, delays, or denies a health care service, based in whole or in part on medical necessity, to automatically submit within 24 hours a decision regarding a disputed health care service to the Independent Medical Review System, as well as the information that informed its decision, without requiring an enrollee or insured to submit a grievance, if the decision is to deny, modify, or delay specified services relating to mental health or substance use disorder conditions for an enrollee or insured up to 26 years of age. The bill would require a health care service plan or disability insurer, within 24 hours after submitting its decision to the Independent Medical Review System to provide notice to the appropriate department, the enrollee or insured or their representative, if any, and the enrollee's or insured's provider. The bill would require the notice to include notification to the enrollee or insured that they or their representative may cancel the independent medical review at any time before a determination, as specified. The bill would apply specified existing provisions relating to mental health and substance use disorders for purposes of its provisions, and would be subject to relevant provisions relating to the Independent Medical Review System that do not otherwise conflict with the express requirements of the bill. With respect to health care service plans, the bill would specify that its provisions do not apply to Medi-Cal managed care plan contracts. The bill would authorize the Insurance Commissioner to promulgate regulations subject to the Administrative Procedure Act to implement and enforce the bill, and to issue interim guidance, as specified. Because a willful violation of this provision by a health care service plan 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 238?
SB 238 is sponsored by Garcia, Wiener, Scott D. (Democratic), Gonzalez, Lena A. (Democratic), and Newman.
What is the current status of SB 238?
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 238?
Track SB 238 free on One Click Politics — get push/email alerts when it moves.

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