BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 282 (Hernandez) - Health care coverage: prescription drugs
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|Version: April 9, 2015 |Policy Vote: HEALTH 8 - 0 |
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|Urgency: No |Mandate: Yes |
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|Hearing Date: May 4, 2015 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: SB 282 would authorize prescribing providers to use an
electronic process for transmitting prior authorization
information.
Fiscal
Impact:
One-time costs of $134,000 in 2015-16 and $169,000 in 2016-17
to revise existing regulations by the Department of Insurance
(Insurance Fund).
One-time costs of about $90,000 to amend regulations by the
Department of Managed Health Care (Managed Care Fund).
Background: Under current law, the Department of Insurance and the
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Department of Managed Health Care have developed a uniform prior
authorization form that health plans and health insurers
(collectively referred to as "carriers") must accept from
prescribing providers when the carrier requires prior
authorization before certain prescription drugs are authorized
for coverage. The standard form is two pages and by regulation
carriers must accept the standard form in paper form, by
telephone, web portal, or other means of transmission. Under
current law, if a carrier fails to accept the standardized prior
authorization form or fails to respond within two business days,
the request is deemed authorized. (Medi-Cal managed care plans
are required to accept the standardized form but are exempt from
the two business day response requirement and are instead
governed by the requirements of the Medi-Cal program.)
Proposed Law:
SB 282 would authorize prescribing providers to use an
electronic process for transmitting prior authorization
information.
The authority to use an electronic prior authorization process
would be in addition to the existing requirement to use the
standardized prior authorization form.
The electronic prior authorization form must be consistent with
the requirements of the existing standardized form and meet
specified national standards.
The bill exempts contracted network physician groups that have
accepted financial risk for pharmacy benefits, a contracted
network physician group that uses its own internal prior
authorization process, or a contracted physician network that
has been delegated utilization management responsibility by a
carrier.
Staff
Comments: The only costs that may be incurred by a local agency
relate to crimes and infractions. Under the California
Constitution, such costs are not reimbursable by the state.
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