SB 1120 (CA Physicians Make Decisions Act)

SB 1120 (Becker; 2023–2024 Reg. Sess.; Ch. 879, Stats. 2024; approved and chaptered Sept. 28, 2024; non-urgency, operative Jan. 1, 2025) amends Cal. Health & Safety Code § 1367.01 and Cal. Ins. Code § 10123.135. Health care service plans and disability insurers that use an AI, algorithm or other software tool for utilization review must ensure the tool bases determinations on the enrollee's medical or other clinical history and individual clinical circumstances, does not base its determination solely on a group dataset, does not supplant health care provider decision-making, does not discriminate, is fairly and equitably applied, is open to inspection for audit or compliance reviews by the regulator, is disclosed in written policies and procedures, is periodically reviewed and revised, does not use patient data beyond its intended and stated purpose, and does not directly or indirectly cause harm to the enrollee. The tool shall not deny, delay or modify health care services based on medical necessity — only a licensed physician or competent health care professional may make those determinations. DMHC and CDI administer.