March 20, 2023
The California Medical Association (CMA) recently announced its priority bill package for 2023, which includes legislation that would reform prior authorization, expand cultural and linguistic competency, streamline provider credentialing, protect physicians providing reproductive health care and more. Below are summaries of CMA's seven priority bills.
SB 598: Prior Authorization
Senate Bill 598, authored by Senator Nancy Skinner, takes a wholistic approach to reforming the prior authorization process by requiring plans to create exemption programs that allow physicians who are practicing within the plan's criteria 90% of the time to receive a one-year exemption from the plan's prior authorization requirements. Additionally, the legislation will give a treating physician the right to have an appeal of a prior authorization denial conducted by a physician peer of the same or similar specialty. (Delegated physician groups would be exempt from these requirements, meaning the legislation will only apply to health plans.) SB 598 builds on the momentum CMA had last year with a similar bill (SB 250) championed by then Senator Richard Pan, M.D.
AB 470: Expanding Cultural Medical Equity
Assembly Bill 470, authored by Assemblymember Avelino Valencia, affirms the importance of cultural competency and language fluency as a core tenet of continuing medical education (CME) and of keeping CME standards that guide CME providers’ development of curriculum on culturally and linguistically competent care updated on a frequent basis. California has an ever-increasing diversity of language.
SB 582: EHR Vendor Regulation
Recognizing the key role electronic health record (EHR) vendors will play in empowering physicians and other health care providers to comply with California’s Data Exchange Framework (DxF), this bill would require the state entity regulating physician compliance with data exchange regulations to also regulate EHR vendors. Authored by Senator Josh Becker, SB 582 would authorize the California Health and Human Services agency to create policies and procedures for including EHR vendors in the legal structure of the framework, and incorporate federal standards for the reasonableness of vendor fees. These changes will allow regulators to crackdown on exorbitant pricing schemes and guarantee that physicians are not hampered in complying by vendor practices.
AB 815: Streamlining Physician Credentialing
This bill, authored by Assemblymember Jim Wood, would allow health plans and insurers to eliminate outdated and unnecessary administrative processes that divert resources from patient care and coverage by streamlining the credentialing process making practices more efficient and removing administrative red tape. Working with stakeholders to address this issue in a mutually beneficial way, the proposal takes the same approach as the continuing medical education regulatory construct. It would require the creation of a panel to approve independent entities to credential physicians for health plan contracts. If a physician chooses to be credentialed by an approved entity, a health plan would be required to accept the physician’s credential.
AB 765: Truth in Advertising
Health care consumers need increased clarity and transparency in the education and training of their health care providers. Confusing or misleading health care advertising and communications has the potential to put patient safety at risk. This bill, authored by Assemblymember Jim Wood, would ensure health care consumers are not mislead or deceived into believing their health care provider is a physician or surgeon by preventing non-physician health care providers from using terms like “-ologist" or "surgeon" or “medical doctor” or other similar combination of “physician-equivalent” titles.
AB 571: Provider protection for reproductive health
This bill will ensure that licensed medical providers have access to professional liability insurance coverage without discrimination for providing abortion care, contraception and gender affirming care.
SB 487: Prohibits “civil actions” against abortion providers
This bill, authored by Senator Toni Atkins, will protect California health care providers from automatic suspension from the Medi-Cal program if they are suspended from a Medicaid program in another state as a result of providing health care services that are legal in California. It will also prohibit health insurers from discriminating against or refusing to contract with a health care provider who may have been sanctioned in another state as a result of providing health care services that are prohibited or restricted in that state, but are legal in California. SB 487 also strengthens civil protections and provides additional safeguards for California abortion providers and other entities and individuals that serve and support abortion patients that reside in states with hostile abortion laws.
To receive updates on these bills as they make their way through the legislative process, subscribe to CMA Newswire.