10133.12. (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health insurer shall establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:
(1) Patient access API, as described in Section 422.119 (a) to (e), inclusive, of Title 42 of the Code of Federal Regulations.
(2) Provider directory API, as described in Section 422.120 of the Code of Federal Regulations.
(3) Payer-to-payer exchange API, as described in Section 422.119(f) of the Code of Federal Regulations.
(b) In addition to the API described in subdivision (a), the department may require a health insurer to establish and maintain the following API if and when final rules are published by the federal government:
(1) Provider access API.
(2) Prior authorization support API.
(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.
(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.
(Added by Stats. 2022, Ch. 888, Sec. 4. (SB 1419) Effective January 1, 2023.)
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