All Roll Calls
Yes: 199 • No: 0
CaliforniaSB 4022025-2026 Regular SessionSenateWALLET
Health care coverage: autism.
Sponsored By: Suzette Martinez Valladares (Republican)
Signed by Governor
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Bill Overview
Analyzed Economic Effects
11 provisions identified: 6 benefits, 2 costs, 3 mixed.
Easier autism care and no rediagnosis
Beginning January 1, 2026, plans and insurers cannot require a new autism diagnosis to keep behavioral health treatment, and they cannot pause or stop existing care while waiting. Directories must list qualified autism service providers, and plans must keep an adequate network of them and their supervised staff, except for specialized plans and Medi‑Cal contracts. The law recognizes qualified autism service providers and professionals as health care providers for telehealth, so they can deliver care by telehealth under standard rules. Disability insurance rules also recognize these qualified autism providers, which can support coverage and payment.
In-network costs when directories are wrong
If you reasonably rely on wrong provider directory information for a covered service, your insurer must honor in-network costs. You pay no more than in-network copays or coinsurance, and it counts toward your deductible and out-of-pocket max. The insurer must arrange covered care and reimburse any extra you paid above in-network amounts. Plans must also answer network status questions fast: phone requests get a written follow-up within two business days; electronic requests get a reply within one business day.
Clear roles for autism therapy providers
The law defines who counts as a qualified autism service provider, professional, and paraprofessional. Services must be supervised and follow a treatment plan set by a qualified provider. Plans must include measurable goals, service type, hours, and parent participation, and be reviewed at least every six months. Treatment plans cannot pay for respite, daycare, or school services.
Easier to find in-network providers
Plans publish public, searchable online directories listing only current in-network providers. They update the online list at least weekly. You can search by name, address, city, ZIP code, license, or NPI. On request, a printed directory is mailed within five business days and updated at least quarterly. Each listing shows specialty, license and NPI, languages, and if taking new patients, and it includes qualified autism providers.
Stronger directories and billing protections
Beginning July 1, 2026, plans and insurers must list only current in‑network providers and keep directories public and searchable online. They must update online listings at least weekly, mail printed copies within five business days, and show the last update date. Plans must verify providers every 6–12 months, remove inactive listings after notice, and meet accuracy goals: 60% by 7/1/2026, 80% by 7/1/2027, 90% by 7/1/2028, and 95% by 7/1/2029, with penalties that adjust every five years starting 1/1/2030. If you reasonably relied on wrong directory or tier information, you only owe in‑network or lower‑tier costs, and the plan must arrange and pay for covered care and refund overcharges. The law also requires clear reporting channels, free interpreter and disability access info, fast answers to network questions, truthful network ads, MEWA compliance, and allows a central data utility to improve accuracy. A 10% network change triggers a filing, and 10% long‑unresponsive listings trigger a corrective plan starting 7/1/2026.
Payment holds and contract risk for providers
Plans and insurers may delay payments when a provider does not respond to directory verification after required notices. For capitation, a plan may hold up to 50% of the next payment for up to one month; for claims, payment may be delayed up to one month. Repeated failure to update information can lead to contract termination. Regulators review insurer use of this payment‑delay authority during routine examinations.
Stronger rules for accurate provider directories
Health plans must meet accuracy goals for provider directories: 60% by July 1, 2026; 80% by July 1, 2027; 90% by July 1, 2028; and 95% by July 1, 2029. The state can fine plans that miss the goals, with penalty amounts updated every five years starting January 1, 2029. Plans must verify directory data each year, post an accuracy report, ask providers to confirm details, try to verify within 30 business days if no reply, and give 10 business days’ notice before removal. If providers do not respond after notices, plans may delay provider payments for up to one calendar month but must pay within three business days after getting the info. Plans must report if a region’s network changes by 10%, the state defines who counts as “actively participating” (no higher bar than one claim every three years), and the department can require a central directory data utility starting January 1, 2026; some standards are exempt from normal rulemaking until January 1, 2029 and initial standards began December 31, 2016.
Abuse-reporting training in schools and childcare
Starting July 1, 2026, private schools must train covered staff every year on child abuse reporting. Childcare license applicants and staff must take training within 90 days of hire and renew every two years. Covered employers must provide training, and workers may use the state’s online course.
Broader child abuse reporting duties
Qualified autism service providers, professionals, and paraprofessionals are now mandated reporters of child abuse. Most volunteers are not mandated reporters, except for specific roles named in law, but they are encouraged to train and report. Lack of training does not excuse a mandated reporter from reporting. Employers of commercial computer technicians may name a designated reporter; reporting to that person counts and carries legal protections.
Clear consent and rules for telehealth
Before a telehealth visit, your provider must explain telehealth, get your verbal or written consent, and record it. Breaking telehealth rules is unprofessional conduct and can lead to discipline. Hospitals may grant telehealth privileges using credential info from the distant site, consistent with federal rules.
Some directory rules skip Medi-Cal plans
The directory rules apply to Medi‑Cal managed care plans only as allowed by federal law and later state guidance. Several listed directory protections do not apply to Medi‑Cal contracts with the state. This means Medi‑Cal enrollees may see fewer of these new directory safeguards.
Sponsors & Cosponsors
Sponsor
Suzette Martinez Valladares
Republican • Senate
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
Senate vote • 9/11/2025
Item 39 — Senate SFLOOR
Yes: 40 • No: 0
House vote • 9/9/2025
Item 25 — Assembly AFLOOR
Yes: 77 • No: 0
legislature vote • 7/15/2025
Vote in CX08
Yes: 15 • No: 0
legislature vote • 7/1/2025
Vote in CX33
Yes: 17 • No: 0
Senate vote • 6/3/2025
Item 16 — Senate SFLOOR
Yes: 39 • No: 0
legislature vote • 4/21/2025
Vote in CS42
Yes: 11 • No: 0
Actions Timeline
Chaptered by Secretary of State. Chapter 413, Statutes of 2025.
10/6/2025SenateApproved by the Governor.
10/6/2025legislatureEnrolled and presented to the Governor at 2 p.m.
9/22/2025legislatureAssembly amendments concurred in. (Ayes 40. Noes 0. Page 2873.) Ordered to engrossing and enrolling.
9/11/2025SenateIn Senate. Concurrence in Assembly amendments pending.
9/9/2025SenateRead third time. Passed. (Ayes 77. Noes 0. Page 3065.) Ordered to the Senate.
9/9/2025HouseOrdered to third reading.
9/5/2025HouseRead third time and amended.
9/5/2025HouseAssembly Rule 69(b)(1) suspended.
9/5/2025HouseOrdered to third reading.
8/27/2025HouseRead third time and amended.
8/27/2025HouseRead second time. Ordered to third reading.
7/17/2025HouseFrom committee: Do pass. (Ayes 15. Noes 0.) (July 15).
7/16/2025HouseFrom committee: Do pass and re-refer to Com. on HEALTH. (Ayes 17. Noes 0.) (July 1). Re-referred to Com. on HEALTH.
7/1/2025HouseReferred to Coms. on B. & P. and HEALTH.
6/9/2025HouseIn Assembly. Read first time. Held at Desk.
6/4/2025HouseRead third time. Passed. (Ayes 39. Noes 0. Page 1469.) Ordered to the Assembly.
6/3/2025SenateRead second time. Ordered to third reading.
4/22/2025SenateFrom committee: Do pass. (Ayes 11. Noes 0. Page 808.) (April 21).
4/21/2025SenateSet for hearing April 21.
3/18/2025SenateReferred to Com. on B. P. & E.D.
2/26/2025SenateFrom printer. May be acted upon on or after March 17.
2/18/2025SenateIntroduced. Read first time. To Com. on RLS. for assignment. To print.
2/14/2025Senate
Bill Text
Chaptered
10/6/2025
Enrolled
9/16/2025
Amended Assembly
9/5/2025
Amended Assembly
8/27/2025
Introduced
2/14/2025