CORONAVIRUS (COVID-19) RESOURCE CENTER Read More

CA AB 236

Title: Health care coverage: provider directories.
Author: Christopher R. Holden

Summary
AB 236, as amended, Holden. Health care coverage: provider directories. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan and a health insurer that contracts with providers for alternative rates of payment to publish and maintain a provider directory or directories with information on contracting providers that deliver health care services enrollees or insureds, and requires a health care service plan and health insurer to regularly update its printed and online provider directory or directories, as specified. Existing law authorizes the departments to require a plan or insurer to provide coverage for all covered health care services provided to an enrollee or insured who reasonably relied on materially inaccurate, incomplete, or misleading information contained in a health plan’s provider directory or directories.This bill would require a plan or insurer to annually verify and delete inaccurate listings from its provider directories, and would require a provider directory to be 60% accurate on July 1, 2025, with increasing required percentage accuracy benchmarks to be met each year until the directories are 95% accurate on or before July 1, 2028. The bill would subject a plan or insurer to administrative penalties for failure to meet the prescribed benchmarks. If a plan or insurer has not financially compensated a provider in the prior year, the bill would require the plan or insurer to delete the provider from its directory beginning July 1, 2025, unless specified criteria applies. The bill would require a plan or insurer to arrange care and provide coverage for all covered health care services provided to an enrollee or insured who reasonably relied on inaccurate, incomplete, or misleading information contained in a health plan or policy’s provider directory or directories and to reimburse the provider the contracted amount for those services. The bill would prohibit a provider from collecting an additional amount from an enrollee or insured other than the applicable in-network cost sharing. The bill would require a plan or insurer to provide information about in-network providers to enrollees and insureds upon request, and would limit the cost-sharing amounts an enrollee or insured is required to pay for services from those providers under specified circumstances.This bill would authorize the Department of Managed Health Care and the Department of Insurance to develop uniform formats for plans and insurers to use to request directory information from providers and would authorize the departments to establish a methodology and processes to ensure accuracy of provider directories. The bill would require the health plan or the insurer, as applicable, to ensure the accuracy of a request to add back a provider who was previously removed from a directory and approve the request within 10 business days of receipt, if accurate.Because a violation of the bill’s requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.

Status
In committee: Set, first hearing. Hearing canceled at the request of author.

Bill Documents
CA AB 236 - 01/22/24 - Amended Assembly
01/22/24 - CA AB 236 (01/22/24 - Amended Assembly)


CA AB 236 - 03/20/23 - Amended Assembly
03/20/23 - CA AB 236 (03/20/23 - Amended Assembly)

CA AB 236 - 02/14/23 - Amended Assembly
02/14/23 - CA AB 236 (02/14/23 - Amended Assembly)

CA AB 236 - 01/13/23 - Introduced
01/13/23 - CA AB 236 (01/13/23 - Introduced)

Add To Favorites

Author Details


  • Chris Holden - D
    Assemblyman - State Assembly - CA

    Contact this Assemblyman
    Visit their Website

    Contact Tips

    Capital Address:
    P.O. Box 942849, 1021 O Street, Suite 5650
    Sacramento, CA 94249-0041
    9163192041

    District Address:
    600 N Rosemead Blvd Ste 117
    Pasadena, CA 91107 2153
    Phone: 6263511917
    Fax: 6263516176