California Assembly Bill 3275
Session 20232024
Health care coverage: claim reimbursement.
Became Law
Became Law on Sep 27, 2024
Sponsors
2 Sponsors
Esmeralda Soria
Robert Rivas
First Action
Feb 16, 2024
Latest Action
Sep 27, 2024
Origin Chamber
Assembly
Type
Bill
Bill Number
3275
State
California
Session
20232024
Motion Text
AB 3275 Soria Concurrence in Senate Amendments
Assembly Roll Call Votes
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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 requires a health insurer or health care service plan, including a specialized health care service plan, to reimburse a claim or portion of a claim no later than 30 working days after receipt of the claim, unless the plan contests or denies the claim, in which case the plan is required to notify the claimant within 30 working days that the claim is contested or denied. Under existing law, if a claim or portion thereof is contested on the basis that a health insurer or health care service plan has not received all information necessary to determine payer liability for the claim or portion thereof and notice has been provided, the health insurer or health care service plan has 30 working days after receipt of the additional information to complete reconsideration of the claim. Existing law extends these timelines to 45 working days for a health care service plan that is a health maintenance organization. Under existing law, if a claim is not reimbursed, contested, or denied pursuant to these timelines, as specified, interest accrues at a rate of 15% per annum for a health care service plan and 10% per annum for a health insurer.
Commencing January 1, 2026, this bill instead would require a health care service plan, including a Medi-Cal managed care plan, or health insurer to reimburse a complete claim or a portion thereof within 30 calendar days after receipt of the claim, or, if a claim or portion thereof does not meet the criteria for a complete claim or portion thereof, to notify the claimant as soon as practicable, but no later than 30 calendar days that the claim or portion thereof is contested or denied. The bill would authorize the departments to issue guidance and regulations related to these provisions. The bill would exempt the guidance and amendments from the Administrative Procedure Act until December 31, 2027.
Existing law requires health care service plans to establish a grievance process, as specified.
This bill would require a complaint made by an enrollee to a health care service plan about a delay or denial of a payment of a claim to be treated as a grievance subject to that grievance process.
Because a willful violation of these provisions 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.
02/16/24 - Introduced
February 16, 2024
04/01/24 - Amended Assembly
April 1, 2024
04/18/24 - Amended Assembly
April 18, 2024
05/16/24 - Amended Assembly
May 16, 2024
06/27/24 - Amended Senate
June 27, 2024
08/23/24 - Amended Senate
August 23, 2024
09/03/24 - Enrolled
September 3, 2024
09/27/24 - Chaptered
September 27, 2024
04/12/24- Assembly Health
April 12, 2024
05/14/24- Assembly Appropriations
May 14, 2024
05/20/24- ASSEMBLY FLOOR ANALYSIS
May 20, 2024
06/24/24- Senate Health
June 24, 2024
08/02/24- Senate Appropriations
August 2, 2024
08/19/24- Sen. Floor Analyses
August 19, 2024
08/25/24- Sen. Floor Analyses
August 25, 2024
08/29/24- ASSEMBLY FLOOR ANALYSIS
August 29, 2024
Sort by most recent
09/27/2024
California State Legislature
Chaptered by Secretary of State - Chapter 763, Statutes of 2024.
09/27/2024
California State Legislature
Approved by the Governor.
09/11/2024
California State Legislature
Enrolled and presented to the Governor at 4 p.m.
08/29/2024
Assembly
Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 74. Noes 0.).
08/29/2024
Assembly
Assembly Rule 77 suspended.
08/28/2024
Assembly
In Assembly. Concurrence in Senate amendments pending. May be considered on or after August 30 pursuant to Assembly Rule 77.
08/28/2024
Senate
Read third time. Passed. Ordered to the Assembly. (Ayes 38. Noes 0.).
08/26/2024
Senate
Read second time. Ordered to third reading.
08/23/2024
Senate
Read third time and amended. Ordered to second reading.
08/19/2024
Senate
Read second time. Ordered to third reading.
08/15/2024
Senate
From committee: Do pass. (Ayes 7. Noes 0.) (August 15).
08/05/2024
Senate
In committee: Referred to suspense file.
06/27/2024
Senate
Read second time and amended. Re-referred to Com. on APPR.
06/26/2024
Senate
From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 0.) (June 26).
05/29/2024
Senate
Referred to Com. on HEALTH.
05/22/2024
Senate
In Senate. Read first time. To Com. on RLS. for assignment.
05/21/2024
Assembly
Read third time. Passed. Ordered to the Senate. (Ayes 72. Noes 0. Page 5389.)
05/20/2024
Assembly
Read second time. Ordered to third reading.
05/16/2024
Assembly
Read second time and amended. Ordered returned to second reading.
05/16/2024
Assembly
From committee: Amend, and do pass as amended. (Ayes 11. Noes 0.) (May 16).
05/16/2024
Assembly
Joint Rule 62(a), file notice suspended. (Page 5215.)
05/16/2024
Assembly
Assembly Rule 63 suspended.
05/15/2024
Assembly
In committee: Set, first hearing. Referred to APPR. suspense file.
04/22/2024
Assembly
Re-referred to Com. on APPR.
04/18/2024
Assembly
Read second time and amended.
04/17/2024
Assembly
From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 16. Noes 0.) (April 16).
04/02/2024
Assembly
Re-referred to Com. on HEALTH.
04/01/2024
Assembly
From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.
03/11/2024
Assembly
Referred to Com. on HEALTH.
02/17/2024
Assembly
From printer. May be heard in committee March 18.
02/16/2024
Assembly
Read first time. To print.
Sources
Record Created
Feb 17, 2024 12:19:12 PM
Record Updated
Oct 22, 2024 12:29:27 PM