CA SB 363
Status unknownHealth care coverage: independent medical review.
California · 2025-2026 Regular Session · upper
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Quick answers
Did CA SB 363 pass?
The current status of CA SB 363 is not known from the official record. Latest recorded action (2026-08-13): August 13 hearing: Held in committee and under submission.
What is CA SB 363 about?
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 establishes the Independent Medical Review System within each department, under which an enrollee or insured may seek review if a health care service has been denied, modified, or delayed by a health care service plan or health insurer and the enrollee or insured has previously filed a grievance that remains unresolved after 30 days. This bill would require a health care service plan or health insurer to annually report to the appropriate department the total number of claims processed by the health care service plan or health insurer for the prior year and its number of treatment denials or modifications, separated and disaggregated as specified, commencing on or before June 1, 2026. The bill would require the departments to compare the number of a health care service plan's or health insurer's treatment denials and modifications to (1) the number of successful independent medical review overturns of the plan's or insurer's treatment denials or modifications and (2) the number of treatment denials or modifications reversed by a plan or insurer after an independent medical review for the denial or modification is requested, filed, or applied for. For a health care service plan or health insurer with 10 or more independent medical reviews in a given year, the bill would make the health care service plan or health insurer liable for an administrative penalty, as specified, if more than 50% of the independent medical reviews filed with a health care service plan or health insurer result in an overturning or reversal of a treatment denial or modification in any one individual category of specified general types of care. The bill would make a health care service plan or health insurer liable for additional administrative penalties for each independent medical review resulting in an additional overturned or reversed denial or modification in excess of that threshold. The bill would require the departments to annually include data, analysis, and conclusions relating to these provisions in specified reports. Because a willful violation of these provisions by a health care service plan would be a crime, this bill would impose a state-mandated local program. Existing law creates the Managed Care Administrative Fines and Penalties Fund in the State Treasury for the deposit of fines and administrative penalties collected pursuant to provisions licensing and regulating health care service plans. This bill would create the Managed Care Independent Medical Review Administrative Penalties Subaccount in the Managed Care Administrative Fines and Penalties Fund for the receipt and deposit of moneys generated from the administrative penalties described above with respect to health care service plans. The bill would create the Health Insurance Independent Medical Review Administrative Penalties Fund in the State Treasury for the receipt and deposit of moneys generated from the administrative penalties described above with respect to health insurers. The bill would authorize the moneys in the Managed Care Independent Medical Review Administrative Penalties Subaccount and Health Insurance Independent Medical Review Administrative Penalties Fund to be expended, as specified, upon appropriation by the Legislature. This bill would declare that its provisions are severable. 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.
Who sponsors CA SB 363?
Wiener is the primary sponsor of CA SB 363, joined by 4 cosponsors.
Description
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 establishes the Independent Medical Review System within each department, under which an enrollee or insured may seek review if a health care service has been denied, modified, or delayed by a health care service plan or health insurer and the enrollee or insured has previously filed a grievance that remains unresolved after 30 days. This bill would require a health care service plan or health insurer to annually report to the appropriate department the total number of claims processed by the health care service plan or health insurer for the prior year and its number of treatment denials or modifications, separated and disaggregated as specified, commencing on or before June 1, 2026. The bill would require the departments to compare the number of a health care service plan's or health insurer's treatment denials and modifications to (1) the number of successful independent medical review overturns of the plan's or insurer's treatment denials or modifications and (2) the number of treatment denials or modifications reversed by a plan or insurer after an independent medical review for the denial or modification is requested, filed, or applied for. For a health care service plan or health insurer with 10 or more independent medical reviews in a given year, the bill would make the health care service plan or health insurer liable for an administrative penalty, as specified, if more than 50% of the independent medical reviews filed with a health care service plan or health insurer result in an overturning or reversal of a treatment denial or modification in any one individual category of specified general types of care. The bill would make a health care service plan or health insurer liable for additional administrative penalties for each independent medical review resulting in an additional overturned or reversed denial or modification in excess of that threshold. The bill would require the departments to annually include data, analysis, and conclusions relating to these provisions in specified reports. Because a willful violation of these provisions by a health care service plan would be a crime, this bill would impose a state-mandated local program. Existing law creates the Managed Care Administrative Fines and Penalties Fund in the State Treasury for the deposit of fines and administrative penalties collected pursuant to provisions licensing and regulating health care service plans. This bill would create the Managed Care Independent Medical Review Administrative Penalties Subaccount in the Managed Care Administrative Fines and Penalties Fund for the receipt and deposit of moneys generated from the administrative penalties described above with respect to health care service plans. The bill would create the Health Insurance Independent Medical Review Administrative Penalties Fund in the State Treasury for the receipt and deposit of moneys generated from the administrative penalties described above with respect to health insurers. The bill would authorize the moneys in the Managed Care Independent Medical Review Administrative Penalties Subaccount and Health Insurance Independent Medical Review Administrative Penalties Fund to be expended, as specified, upon appropriation by the Legislature. This bill would declare that its provisions are severable. 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.
- Introduced
- 2025-02-13
- Latest action
- 2026-08-13 — August 13 hearing: Held in committee and under submission.
- Bill type
- bill
- Last updated
- —
Subjects
Sponsors
- Wienerauthor
- Beckercoauthor
- Cortesecoauthor
- Weber Piersoncoauthor
- Schiavocoauthor
Committees
Not provided by source.
Action timeline
Newest first
2026-08-13
August 13 hearing: Held in committee and under submission.
2025-08-29
August 29 hearing postponed by committee.
2025-08-20
August 20 set for first hearing. Placed on APPR. suspense file.
2025-07-17
Read second time and amended. Re-referred to Com. on APPR.
amendment-passage,reading-1,reading-2,referral-committee
2025-07-16
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 13. Noes 0.) (July 15).
amendment-passage,committee-passage,committee-passage-favorable,referral-committee
2025-06-24
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
amendment-passage,committee-passage,reading-1,reading-2,referral-committee
2025-06-05
Referred to Com. on HEALTH.
referral-committee
2025-05-28
In Assembly. Read first time. Held at Desk.
reading-1
2025-05-28
Read third time. Passed. (Ayes 29. Noes 8. Page 1291.) Ordered to the Assembly.
passage,reading-1,reading-3
2025-05-27
Read second time. Ordered to third reading.
reading-1,reading-2,reading-3
2025-05-23
From committee: Do pass as amended. (Ayes 5. Noes 1. Page 1198.) (May 23).
amendment-passage,committee-passage,committee-passage-favorable
2025-05-23
Read second time and amended. Ordered to second reading.
amendment-passage,reading-1,reading-2
2025-05-16
Set for hearing May 23.
2025-04-28
April 28 hearing: Placed on APPR. suspense file.
2025-04-17
Set for hearing April 28.
2025-04-10
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 9. Noes 2. Page 737.) (April 9).
amendment-passage,committee-passage,committee-passage-favorable,referral-committee
2025-04-10
Read second time and amended. Re-referred to Com. on APPR.
amendment-passage,reading-1,reading-2,referral-committee
2025-03-26
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
amendment-passage,committee-passage,reading-1,reading-2,referral-committee
2025-03-26
April 2 hearing postponed by committee.
2025-03-26
Set for hearing April 9.
2025-03-17
Set for hearing April 2.
2025-02-26
Referred to Com. on HEALTH.
referral-committee
2025-02-14
From printer. May be acted upon on or after March 16.
2025-02-13
Introduced. Read first time. To Com. on RLS. for assignment. To print.
introduction,reading-1,referral-committee
Versions
- 02/13/25 - Introduced — 2025-02-13Compare
- 03/26/25 - Amended Senate — 2025-03-26Compare
- 04/10/25 - Amended Senate — 2025-04-10Compare
- 05/23/25 - Amended Senate — 2025-05-23Compare
- 06/24/25 - Amended Assembly — 2025-06-24Compare
- 07/17/25 - Amended Assembly — 2025-07-17Compare
- SB363Compare
- (document, no version)Compare
Documents
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Votes
Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations]
2025-04-09 · pass · 9-2
Member-level votes (11)
- Menjivar: yes
- Richardson: yes
- Rubio: yes
- Gonzalez: yes
- Limón: yes
- Weber Pierson: yes
- Wiener: yes
- Durazo: yes
- Padilla: yes
- Valladares: no
- Grove: no
Placed on suspense file
2025-04-28 · pass · 7-0
Member-level votes (7)
- Seyarto: yes
- Grayson: yes
- Caballero: yes
- Cabaldon: yes
- Wahab: yes
- Richardson: yes
- Dahle: yes
Do pass as amended
2025-05-23 · pass · 5-1
Member-level votes (7)
- Caballero: yes
- Wahab: yes
- Cabaldon: yes
- Richardson: yes
- Grayson: yes
- Seyarto: no
- Dahle: other
3rd Reading SB363 Wiener et al.
2025-05-28 · pass · 29-8
Member-level votes (40)
- McNerney: yes
- Cabaldon: yes
- Allen: yes
- Padilla: yes
- Cervantes: yes
- Gonzalez: yes
- Smallwood-Cuevas: yes
- Laird: yes
- Becker: yes
- Rubio: yes
- Caballero: yes
- Arreguín: yes
- Wahab: yes
- Weber Pierson: yes
- Archuleta: yes
- McGuire: yes
- Richardson: yes
- Blakespear: yes
- Cortese: yes
- Hurtado: yes
- Dahle: yes
- Durazo: yes
- Ashby: yes
- Grayson: yes
- Wiener: yes
- Stern: yes
- Pérez: yes
- Umberg: yes
- Menjivar: yes
- Alvarado-Gil: no
- Grove: no
- Niello: no
- Strickland: no
- Choi: no
- Seyarto: no
- Valladares: no
- Jones: no
- Limón: other
- Reyes: other
- Ochoa Bogh: other
Do pass as amended and be re-referred to the Committee on [Appropriations]
2025-07-15 · pass · 13-0
Member-level votes (16)
- Bonta: yes
- Caloza: yes
- Stefani: yes
- Sharp-Collins: yes
- Krell: yes
- Celeste Rodriguez: yes
- Carrillo: yes
- Addis: yes
- Chen: yes
- Mark González: yes
- Aguiar-Curry: yes
- Schiavo: yes
- Patel: yes
- Sanchez: other
- Flora: other
- Patterson: other
Related bills
No related bills recorded for this bill.
Official source
Attribution
Data from openstates_api_sync, retrieved 2026-10-28T05:47:58.726883Z
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