CommercialAdministrativeMedium impact
24-1311 Delegated PPGs: Follow Requirements for Use of AI in Utilization Review and Management
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
California Senate Bill 1120 requires Health Net's delegated physician groups (PPGs) using AI tools for utilization review to implement specific oversight policies, documentation requirements, and ensure human physician decision-making for medical necessity determinations. This applies only to specific California counties for Medi-Cal and all California counties for other Health Net plans.
Action Required
By January 1, 2025: If your practice is a delegated PPG with Health Net using AI for utilization review, develop written policies documenting AI oversight procedures, ensure AI tools do not make final medical necessity decisions (only licensed physicians can), and implement periodic accuracy reviews of AI systems. Contact appropriate Health Net Provider Services for guidance on compliance requirements.