Health care coverage: prior authorization.

Chapter 8.75 (commencing with Section 14591) was removed from the list of Medi-Cal managed care plan contract chapters excluded from the new accelerated prior authorization timelines. Plans contracting under this chapter are now subject to the shorter deadlines (3 business days for standard electronic submissions, 24 hours for urgent cases) rather than retaining the longer existing timelines (5 business days, 72 hours).

All other changes are formatting and procedural: removal of amendment history headers, line numbers, internal page tracking marks, and replacement with enrolled bill formatting including clerk signatures, governor receipt lines, and chapter numbering.

The formal enrolled bill document (with Governor receipt date, clerk signatures, chapter number, and page headers/footers) was replaced by a web-based presentation of the same bill text, including website navigation elements, quick search fields, version history listing, and status metadata showing the bill was enrolled on September 12, 2025.

Senate amendment date updated from September 4, 2025 to September 5, 2025

Typo corrected in bill summary: 'a health care service plan plan' changed to 'a health care service plan'

Page numbers renumbered from 95 to 94 throughout the document due to formatting adjustments

Standard prior/concurrent authorization decision timeline changed from 48 hours to 3 business days for electronic submissions or 5 business days for non-electronic submissions. This is a relaxation, not a tightening, of the deadline.

Urgent request timelines are now explicitly tied to submission method: 24 hours for electronic submission or 48 hours for non-electronic submission (previously stated as a flat 24 hours).

New paragraph (h)(3) creates a separate, more lenient timeline specifically for Medi-Cal managed care plans: 5 business days for standard requests and 72 hours for urgent requests, compared to 3-5 business days and 24-48 hours for other health care service plans.

The bill summary was updated to note that the bill 'would exclude Medi-Cal managed care plans from the above-described timeline changes,' making the exemption explicit in the legislative findings.

Paragraph (h)(2) is narrowed from covering both 'prior to, or concurrent with' service to only 'concurrent with' service. This means the 5-business-day decision timeframe no longer applies to prior-to-service requests; those must now be decided within 48 hours under paragraph (h)(1).

Paragraph (h)(3) is narrowed from covering 'prior to, or concurrent with' service to only 'concurrent with' service. The 72-hour urgent decision timeframe now applies exclusively to concurrent reviews, not prior-to-service requests.

Subdivision (e) changes from 'may not deny or modify' to 'shall not deny or modify' for non-licensed individuals making medical necessity determinations, using stronger mandatory language.

Subdivision (k)(1)(C) adds 'including, but not limited to' before the reference to Section 1363.5, broadening the compliance requirement for AI/algorithm criteria and guidelines beyond just that specific section.

The definition of 'urgent' in paragraph (h)(1) adds 'including, but not limited to' before listing potential loss of life, limb, or other major bodily function, making the definition non-exhaustive and potentially broader in scope.

Multiple grammatical corrections throughout, including fixing 'No An individual' to 'An individual,' removing duplicate words like 'including including,' and correcting 'Nothing in this This section shall not cause' to 'This section shall not cause.'

Page numbering changed from 99 to 98 throughout the document, and the digest header updated from 'as introduced' to 'as amended.'

Section 1(h)(2): The deadline for non-urgent concurrent review decisions was shortened from five business days to 48 hours. This means plans must approve, modify, or deny requests made during ongoing treatment within 48 hours instead of roughly five working days.

Section 1(h)(3): The deadline for urgent concurrent review decisions (where the enrollee faces an imminent and serious threat to health) was shortened from 72 hours to 24 hours. This triples the speed requirement for the most time-sensitive cases.

The legislative counsel's digest was updated to describe the bill as shortening timelines for 'prior or concurrent authorization requests' rather than just 'prior authorization requests,' more accurately reflecting that the bill covers both pre-treatment and during-treatment reviews.

Assembly Member Patel was added as a coauthor of the bill.

Multiple instances of the typo 'including including' were corrected to 'including' throughout the text.