MedicaidAdministrativeMedium impact
24-1313 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 delegated physician groups (PPGs) that use AI for utilization review to implement new compliance requirements by January 1, 2025. PPGs must establish written policies for AI oversight, ensure AI doesn't make final medical necessity decisions (only licensed providers can), and regularly review AI tools for accuracy and non-discrimination.
Action Required
By January 1, 2025: Delegated PPGs in Imperial County must develop written policies and procedures for AI oversight in utilization review processes. Billing teams should verify their PPG has compliant AI policies that ensure licensed physicians make all final medical necessity determinations. Contact Community Health Plan of Imperial Valley at 833-236-4141 if questions arise about compliance requirements.