BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          SB 137 (Hernandez) - Health care coverage:  provider directories
          
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          |Version: April 21, 2015         |Policy Vote: HEALTH 8 - 0       |
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          |Urgency: No                     |Mandate: Yes                    |
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          |Hearing Date: May 4, 2015       |Consultant: Brendan McCarthy    |
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          This bill meets the criteria for referral to the Suspense File.



          


          Bill  
          Summary:  SB 137 would require a health plan or insurer to make  
          available a directory of contracting providers, with specified  
          requirements for completeness and accuracy. The bill would  
          require the Department of Insurance and Department of Managed  
          Health Care to develop uniform standards for the provider  
          directories.


          Fiscal  
          Impact:  
           One-time costs of about $160,000 in 2015-16 and $200,000 in  
            2016-17 to work with stakeholders, develop standards, and  
            issue regulations by the Department of Insurance (Insurance  
            Fund).

           One-time costs, likely between $150,000 and $300,000 to work  







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            with stakeholders, develop standards, and issue regulations by  
            the Department of Managed Health Care (Managed Care Fund).
            
           Unknown costs to develop and operate a "single uniform  
            electronic directory" (General Fund or special funds). The  
            bill includes a provision that requires the data standards  
            developed by the Department of Insurance and Department of  
            Managed Health Care should be sufficient to permit a single  
            uniform electronic directory to allow members of the public to  
            determine whether a provider is available to enrollees of  
            health care coverage offered through Covered California,  
            Medi-Cal, or enrollees with group coverage. The bill does not  
            specify who would create or operate such a directory. If the  
            Department of Insurance, the Department of Managed Health  
            Care, and/or Covered California were to develop such a system,  
            the costs are likely to be in the millions to tens of  
            millions.

           No significant costs to the Medi-Cal program are anticipated.  
            The Department of Health Care Services indicates that any  
            additional costs to Medi-Cal managed care plans would not  
            likely lead to increased rates paid to those plans by the  
            state.


          Background:  Current law requires health plans and insurers (collectively  
          referred to as "carriers") to provide an enrollee or prospective  
          enrollee with a list of contracting providers (such as  
          physicians, hospitals, medical groups, and other provider  
          types). Carriers are required to update information in their  
          directories at least quarterly.


          Proposed Law:  
            SB 137 would require a health plan or insurer to make  
          available a directory of contracting providers, with specified  
          requirements for completeness and accuracy. 
          Specific provisions of the bill would:


           Require carriers to make available a provider directory that  
            includes information on contracting providers, including  
            information on which contracting providers are accepting new  
            patients;








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           Require the provider networks to use consistent systems for  
            identifying providers;
           Require the provider directory to be available to the public  
            without any requirement that a member of the public indicate  
            intent to enroll, provide any identifying information, or  
            create an account with the provider;
           Require the carrier to update the provider directory at least  
            weekly;
           Specify the information that must be included for each  
            provider, including location, specialties, non-English  
            languages spoken, affiliation with hospitals, and other  
            information;
           Require the Department of Insurance and the Department of  
            Managed Health care to develop provider directory standards by  
            March 15, 2016;
           Require the standards developed to be sufficient to permit a  
            single uniform electronic directory to allow a member of the  
            public to determine whether a provider is available to  
            enrollees of Covered California, Medi-Cal managed care, and  
            group market coverage;
           Require carriers to use the data standards developed by the  
            Departments within six months of their development;
           Require information in the provider directories to be at least  
            97 percent accurate;
           Require carriers to take specified actions to ensure the  
            accuracy of the directories.


          Related  
          Legislation:  SB 964 (Hernandez, Statutes of 2014) increased the  
          oversight of carrier networks and compliance with existing  
          timely access requirements.


          Staff  
          Comments:  As was mentioned above, the bill includes a provision  
          requiring the data standards developed by the Department of  
          Insurance and the Department of Managed Health care to be  
          sufficient to permit a single uniform electronic directory. The  
          provision seems to intend that some unspecified entity would  
          create a data system that would collect information from the  
          provider directories of all the licensed carriers and collate  
          that information in a way that makes it possible for a member of  
          the public to determine which carriers (and which specific  








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          products sold by those carriers) include a given provider in  
          their networks. The bill is not explicit about who would develop  
          such  a system. Given that the bill requires carriers to submit  
          all their provider directory information to the Department of  
          Insurance and the Department of Managed Health Care, the intent  
          may be for one or both of those department to create such a  
          system.
          The only costs that may be incurred by a local agency relate to  
          crimes and infractions. Under the California Constitution, such  
          costs are not reimbursable by the state.




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