CMA-Backed Prior Authorization Bills Gain Traction in California Legislature

In a significant step toward faster, more reliable patient care, three California Medical Association (CMA)-backed bills have successfully advanced from their house of origin in the state legislature. These measures, part of the CMA’s “Prioritizing Patients, Empowering Physicians” package, aim to reduce bureaucratic hurdles and ensure that patients receive medically necessary care without undue delays.

Key Reforms to Reduce Delays

The bills specifically target the most burdensome aspects of prior authorization—a process requiring health plan approval before patients can receive physician-recommended treatment:

• AB 512 (Harabedian): This bill would tighten response times for prior authorization requests, requiring health plans to decide within 24 hours for urgent and 48 hours for nonurgent requests, compared to current windows of 72 hours and 5 days, respectively.
• AB 539 (Schiavo): This measure would extend the validity of an approved prior authorization to one year, helping patients avoid repeated paperwork and disruptions in care.
• SB 306 (Becker): This bill requires health plans to eliminate prior authorization for services that are approved 90% of the time or more, streamlining access to frequently approved treatments.

Why It Matters

“Prior authorization is harming patients and undermining physicians’ ability to deliver medically necessary care promptly,” said CMA President Dr. Shannon Udovic-Constant. “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.”

The reforms are a direct response to troubling statistics: according to the American Medical Association, 93% of physicians report that prior authorization delays patient care, and nearly 30% indicate that it has caused serious adverse events, such as hospitalization or worse. The paperwork burden is also immense—physicians and staff spend approximately two full business days each week on these requests, which fuels burnout.

A Path Forward

CMA is determined to keep pushing for these legislative fixes, emphasizing that administrative barriers should never compromise patient care. With these bills moving ahead, California could become a model for removing obstacles to timely medical care and restoring trust in the physician-patient relationship.