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 28, 2015 |Consultant: Brendan McCarthy |
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SUSPENSE FILE. AS AMENDED.
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 (as approved on May 28,
2015):
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
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with stakeholders, develop standards, and issue regulations by
the Department of Managed Health Care (Managed Care Fund).
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;
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;
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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
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.
Author's amendments (as adopted May 28, 2015): clarify that the
required data standards would allow directories to be aggregated
and searchable and would delete reference to a uniform statewide
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directory.
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