In a major step toward reducing delays in care and improving patient outcomes, three bills from the California Medical Association’s (CMA) Prioritizing Patients, Empowering Physicians legislative package have advanced out of their house of origin in the California State Legislature. These CMA-sponsored bills aim to streamline and reform the state’s broken prior authorization system, which has long delayed or denied medically necessary care and overburdened physicians with unnecessary red tape.

The bills are:

• AB 512 (Harabedian) – Requires health plans to respond to urgent prior authorization requests within 24 hours and nonurgent requests within 48 hours, down from the current 72-hour and 5-day standards, respectively.
• AB 539 (Schiavo) – Extends the validity of an approved prior authorization to one year, which would help prevent disruptions to the continuity of care and reduce administrative hurdles.
• SB 306 (Becker) – Requires health plans to remove prior authorization requirements for services that are approved at least 90% of the time, reducing unnecessary red tape for commonly approved treatments.

“Prior authorization is harming patients and undermining physicians’ ability to deliver medically necessary care in a timely manner,” said CMA President Shannon Udovic-Constant, M.D. “The bills in this package will restore clinical decision-making to physicians and protect patients from dangerous delays in care that have been a part of our health care system for too long. Patient care should not be compromised by paperwork and red tape.”

Prior authorization – a process where health plans require approval before a patient can receive treatment prescribed by a physician – has become a significant barrier to treatment. The American Medical Association’s most recent survey on physicians’ experience with prior authorization found that 93% report prior authorization causes delays in care, and more than one in four (29%) report that it has led to serious adverse events, including hospitalization, permanent harm, or death. Prior authorization also imposes significant administrative burdens, with physicians and their staff spending nearly two full business days a week processing prior authorization requests, contributing significantly to burnout.

CMA remains committed to advancing solutions to the harmful and costly delays caused by prior authorization and will continue to advocate for the Prioritizing Patients, Empowering Physicians package to ensure California patients can receive the care they need without unnecessary barriers.