Assembly BillVetoedHealth and Safety
AB 682: Health care coverage reporting.
What AB 682 does, verified March 9, 2026
This bill requires health care service plans and health insurers to report specified prior authorization data and claims information on their internet websites. These reports must be submitted annually by February 1st and must be posted online by April 15th. The reports will be disaggregated by plan or insurer. The departments of managed health care and insurance will be authorized to reject reports and assess administrative penalties for non-compliance. The bill also authorizes the creation of rules and regulations for the form and content of the reports.
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Last action: Consideration of Governor's veto stricken from file. (2026-01-22)Alert me
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| Jan. 22, 2026 | Consideration of Governor's veto stricken from file. |
| Jan. 22, 2026 | Stricken from file. |
| Oct. 06, 2025 | Consideration of Governor's veto pending. |
| Oct. 06, 2025 | Vetoed by Governor. |
| Sep. 22, 2025 | Enrolled and presented to the Governor at 3 p.m. |
Latest bill textEnrolled version, September 12, 2025 · 3,072 words
| Enrolled September 12, 2025 |
| Passed IN Senate September 09, 2025 |
| Passed IN Assembly September 10, 2025 |
| Amended IN Senate September 04, 2025 |
| Amended IN Senate July 17, 2025 |
| Amended IN Senate June 23, 2025 |
CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION
Assembly Bill
No. 682
| Introduced by Assembly Member Ortega (Principal coauthor: Assembly Member Kalra) |
February 14, 2025 |
An act to add Sections 1367.242 and 1371.33 to the Health and Safety Code, and to add Section 10123.133 and 10123.1915 to the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 682, Ortega. Health care coverage reporting.
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 generally authorizes a health care service plan or health insurer to use prior authorization and other utilization review or utilization management functions, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law requires a health care service plan or health insurer to file various reports with the relevant regulating department.
This bill would require a health care service plan or health insurer that imposes prior authorization to report specified prior authorization data from the previous calendar year on its internet website on or before February 1, 2026, for health care service plans, on or before February 1, 2028, for health insurers, and annually on or before February 1 thereafter. The bill would require a health care service plan or health insurer to annually report specified claims and prior authorization data to the relevant department by February 1 of each year, beginning February 1, 2027, for health care service plans and February 1, 2028, for health insurers. The bill would require the departments to post this information, disaggregated by plan or insurer, on their internet websites by April 15 of each year, beginning April 15, 2027, for health care service plans and April 15, 2028, for health insurers. The bill would authorize the Director of the Department of Managed Health Care and the Insurance Commissioner to reject a report required pursuant to these provisions, and would authorize the commissioner to assess an administrative penalty against a health insurer for a failure to correct a deficiency in the report. The bill would authorize the director and commissioner to make rules and regulations specifying the form and content of the reports posted online and submitted to the relevant department, as specified. 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.
The people of the State of California do enact as follows:
SECTION 1.
Section 1367.242 is added to the Health and Safety Code, to read:1367.242.
(a) On or before February 1, 2026, and annually on or before February 1 thereafter, a health care service plan that imposes prior authorization shall report publicly on its internet website prior authorization data, including all of the following from the previous calendar year:(1) A list of items and services that require prior authorization.
(2) The percentage of standard prior authorization requests that were approved, aggregated for all items and services.
(3) The percentage of standard prior authorization requests that were denied, aggregated for all items and services.
(4) The percentage of standard prior authorization requests that were approved after appeal, aggregated for all items and services.
(5) The percentage of prior authorization requests for which the timeframe for review was extended and the request was approved, aggregated for all items and services. This shall include the reasons for extension, aggregated for all items and services.
(6) The percentage of expedited prior authorization requests that were approved, aggregated for all items and services.
(7) The percentage of expedited prior authorization requests that were denied, aggregated for all items and services.
(8) The average and median time that elapsed between the submission of a request and a determination by the plan for standard prior authorizations, aggregated for all items and services.
(9) The average and median time that elapsed between the submission of a request and a decision by the plan for expedited prior authorizations, aggregated for all items and services.
(b) Any entities with which the plan contracts for prior authorization shall report to the plan the information described in subdivision (a), which shall be publicly reported on the plan’s internet website.
(c) The director may make rules and regulations specifying the form and content of the reports required by this section, and may require that the data be verified by the plan or other person subject to this chapter in a manner as the director may prescribe.
SEC. 2.
Section 1371.33 is added to the Health and Safety Code, to read:1371.33.
(a) A health care service plan shall include in an annual plan claims payment and dispute resolution report, or in another report as prescribed by the director, all of the following information for each month:(1) The number of claims processed or adjudicated.
(2) The number of claims denied, adjusted, or contested.
(3) The total cost of claims denied, adjusted, or contested.
(4) The number and total costs of in-network claims denied, adjusted, or contested.
(5) The number and total cost of out-of-network claims denied, adjusted, or contested.
(6) The number and total cost of claims from an enrollee denied, adjusted, or contested.
(7) The number of claims disaggregated by the following:
(A) Claims paid or adjusted within 30 calendar days of claim submission to a contracted network provider and noncontracted provider, disaggregated by provider type.
(B) Claims paid or adjusted beyond 30 calendar days of claim submission to a contracted network provider and noncontracted provider, disaggregated by provider type.
(8) The number and total costs of claims denied, adjusted, or contested, disaggregated by each of the following reasons:
(A) Out-of-network provider.
(B) Excluded service.
(C) Lack of prior authorization or referral.
(D) Medical necessity reasons.
(E) Experimental or investigational treatment.
(F) Lack of efficacy.
(G) Medical records not provided or insufficient information.
(H) Clerical error, including claim form errors, incorrect procedure coding, or incorrect patient or provider information.
(I) Patient ineligibility for coverage.
(J) Lack of timely filing.
(K) Other. If other is designated, the health care service plan shall specify the reason for the denial, adjustment, or contest.
(L) Any other reason the director may prescribe.
(9) On and after January 1, 2029, the number and total costs of claims denied, adjusted, or contested, disaggregated by the following demographic categories:
(A) Age.
(B) Gender identity.
(C) Sex.
(D) Ethnicity.
(E) Disability.
(F) Sexual orientation.
(10) The number and total cost of claims denied, adjusted, or contested, disaggregated by specific medical procedures and diagnoses.
(11) Of contested claims, the number of claims denied that at any point were processed, adjudicated, or reviewed with artificial intelligence or other predictive algorithms.
(b) (1) By February 1 of each year, beginning February 1, 2027, a health care service plan shall submit, in a form and manner prescribed by the department, the data required pursuant to subdivision (a) for the preceding calendar year to the department.
(2) By April 15 of each year, beginning April 15, 2027, the department shall post the information submitted pursuant to this subdivision on its internet website.
(3) Information posted pursuant to this subdivision shall be disaggregated by each health care service plan required to make this filing. If the number of claims disaggregated is for fewer than 11 individuals, the department shall aggregate and report these claims as other claims.
(4) Data and information made public by the department shall be disclosed in a manner that protects the personal information of patients pursuant to deidentification requirements as specified by the department, as well as any state and federal privacy laws, including the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code) and the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191).
(c) The director may reject a report filed pursuant to this section by notifying the plan. Within 30 days after the receipt of the notice, the person shall correct the deficiency, and a failure to correct the deficiency shall be deemed a violation of this chapter. The director shall retain a copy of all rejected filings.
(d) The director may make rules and regulations specifying the form and content of the reports required by this section, and may require that these reports be verified by the plan or other person subject to this chapter in a manner as the director may prescribe. Pursuant to subdivision (c) of Section 11340.9 of the Government Code, the creation of the form is exempt from the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(e) For purposes of this section:
(1) “Adjudicated” means a plan or other person subject to this chapter has made a determination, whether full or partial, regarding claims payment or coverage.
(2) “Adjusted” means the payor reimbursed the claim at a different rate than the provider’s billed charges.
(3) “Artificial intelligence” has the same meaning as in Section 1367.01.
(4) “Claim” means a claim received by a health care service plan asking for a payment or reimbursement by or on behalf of an in-network health care provider that is contracted to be part of the network, a health care provider that is not contracted to be part of the network, or an enrollee of a health care service plan.
(5) “Contested claim” means a claim that is incomplete and without all the information necessary to determine payer liability for the claim, or a claim in which a provider has not granted reasonable access to information concerning provider services.
(6) “Lack of efficacy” means the determination made by the plan that a treatment is not clinically effective.
(7) “Total cost” means the negotiated or expected amount the provider receives from the payer.
SEC. 3.
Section 10123.133 is added to the Insurance Code, to read:10123.133.
(a) A health insurer shall include in an annual plan claims payment and dispute resolution report, or in another report as prescribed by the commissioner, all of the following information for each month:(1) The number of claims processed or adjudicated.
(2) The number of claims denied, adjusted, or contested.
(3) The total cost of claims denied, adjusted, or contested.
(4) The number and total costs of in-network claims denied, adjusted, or contested.
(5) The number and total cost of out-of-network claims denied, adjusted, or contested.
(6) The number and total cost of claims from an insured denied, adjusted, or contested.
(7) The number of claims disaggregated by the following:
(A) Claims paid or adjusted within 30 calendar days of claim submission to a contracted network provider and noncontracted provider, disaggregated by provider type.
(B) Claims paid or adjusted beyond 30 calendar days of claim submission to a contracted network provider and noncontracted provider, disaggregated by provider type.
(8) The number and total costs of claims denied, adjusted, or contested, disaggregated by each of the following reasons:
(A) Out-of-network provider.
(B) Excluded service.
(C) Lack of prior authorization or referral.
(D) Medical necessity reasons.
(E) Experimental or investigational treatment.
(F) Lack of efficacy.
(G) Medical records not provided or insufficient information.
(H) Clerical error, including claim form errors, incorrect procedure coding, or incorrect patient or provider information.
(I) Patient ineligibility for coverage.
(J) Lack of timely filing.
(K) Other. If other is designated, the insurer shall specify the reason for the denial, adjustment, or contest.
(L) Any other reason the department may prescribe.
(9) On and after January 1, 2029, the number and total costs of claims denied, adjusted, or contested, disaggregated by the following demographic categories:
(A) Age.
(B) Gender identity.
(C) Sex.
(D) Ethnicity.
(E) Disability.
(F) Sexual orientation.
(10) The number and total cost of claims denied, adjusted, or contested, disaggregated by specific medical procedures and diagnoses.
(11) Of contested claims, the number of claims denied that at any point were processed, adjudicated, or reviewed with artificial intelligence or other predictive algorithms.
(b) (1) By February 1 of each year, beginning February 1, 2028, a health insurer shall submit, in a form and manner prescribed by the department, the data required pursuant to subdivision (a) for the preceding calendar year to the department.
(2) By April 15 of each year, beginning April 15, 2028, the department shall post the information submitted pursuant to this subdivision on its internet website.
(3) Information posted pursuant to this subdivision shall be disaggregated by each health insurer required to make this filing. If the number of claims disaggregated is for fewer than 11 individuals, the department shall aggregate and report these claims as other claims.
(4) Data and information made public by the department shall be disclosed in a manner that protects the personal information of patients pursuant to deidentification requirements as specified by the department, as well as any state and federal privacy laws, including the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code) and the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191).
(c) (1) The commissioner may reject any report filed pursuant to this subdivision by notifying the health insurer required to make this filing of its rejection and the cause thereof. Within 30 days after the receipt of the notice, the health insurer shall correct the deficiency. The commissioner shall retain a copy of all rejected filings.
(2) The commissioner may assess an administrative penalty against a health insurer for a failure to correct a deficiency as required by paragraph (1).
(d) The commissioner may make rules and regulations specifying the form and content of the reports required by this section, and may require that these reports be verified by the health insurer in a manner as the commissioner may prescribe. Pursuant to subdivision (c) of Section 11340.9 of the Government Code, the creation of the form is exempt from the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(e) For purposes of this section:
(1) “Adjudicated” means a health insurer or other person subject to this chapter has made a determination, whether full or partial, regarding claims payment or coverage.
(2) “Adjusted” means the payor reimbursed the claim at a different rate than the provider’s billed charges.
(3) “Artificial intelligence” has the same meaning as in Section 10123.135.
(4) “Claim” means a claim received by a health insurer asking for a payment or reimbursement by or on behalf of an in-network health care provider that is contracted to be part of the network, a health care provider that is not contracted to be part of the network, or an insured of a health insurer.
(5) “Contested claim” means a claim that is incomplete and without all the information necessary to determine payer liability for the claim, or a claim in which a provider has not granted reasonable access to information concerning provider services.
(6) “Lack of efficacy” means the determination made by the insurer that a treatment is not clinically effective.
(7) “Total cost” means the negotiated or expected amount the provider receives from the payer.
SEC. 4.
Section 10123.1915 is added to the Insurance Code, to read:10123.1915.
(a) On or before February 1, 2028, and annually on or before February 1 thereafter, a health insurer that imposes prior authorization shall report publicly on its internet website prior authorization data, including all of the following from the previous calendar year:(1) A list of items and services that require prior authorization.
(2) The percentage of standard prior authorization requests that were approved, aggregated for all items and services.
(3) The percentage of standard prior authorization requests that were denied, aggregated for all items and services.
(4) The percentage of standard prior authorization requests that were approved after appeal, aggregated for all items and services.
(5) The percentage of prior authorization requests for which the timeframe for review was extended and the request was approved, aggregated for all items and services. This shall include the reasons for extension, aggregated for all items and services.
(6) The percentage of expedited prior authorization requests that were approved, aggregated for all items and services.
(7) The percentage of expedited prior authorization requests that were denied, aggregated for all items and services.
(8) The average and median time that elapsed between the submission of a request and a determination by the insurer for standard prior authorizations, aggregated for all items and services.
(9) The average and median time that elapsed between the submission of a request and a decision by the insurer for expedited prior authorizations, aggregated for all items and services.
(b) Any entities with which the health insurer contracts for prior authorization shall report to the insurer the information described in subdivision (a), which shall be publicly reported on the insurer’s internet website.
(c) The commissioner may make rules and regulations specifying the form and content of the reports required by this section, and may require that the data be verified by the insurer or other person subject to this chapter in a manner as the commissioner may prescribe.
SEC. 5.
No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.Text of AB 682 as enrolled, from the official record. Connect Plus keeps every version and highlights what changed.Compare versions