BILL ANALYSIS Ó SENATE COMMITTEE ON APPROPRIATIONS Senator Ricardo Lara, Chair 2015 - 2016 Regular Session SB 137 (Hernandez) - Health care coverage: provider directories ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: April 21, 2015 |Policy Vote: HEALTH 8 - 0 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: Yes | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: May 4, 2015 |Consultant: Brendan McCarthy | | | | ----------------------------------------------------------------- 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 SB 137 (Hernandez) Page 1 of ? 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; SB 137 (Hernandez) Page 2 of ? 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 SB 137 (Hernandez) Page 3 of ? 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. -- END --