Health care provider credentialing.

Plain English Breakdown

The official source does not provide specific penalties for violating the bill's requirements.

Health Care Provider Credentialing

AB-2457 extends existing requirements for full-service health care plans to include Medi-Cal managed care plans, requiring them to use a specific credentialing form and make decisions about provider credentials within 90 days.

What This Bill Does

• Extends the requirement for full-service health care plans to use the Council for Affordable Quality Healthcare's credentialing form to include Medi-Cal managed care plans starting January 1, 2028.
• Requires Medi-Cal managed care plans to make a decision about provider credentials within 90 days after receiving an application.

Who It Names or Affects

• Health care service plans, including Medi-Cal managed care plans.
• Health care providers applying for network credentialing with these plans.

Terms To Know

Credentialing

The process of verifying a health care provider's qualifications and licensing to ensure they meet certain standards before allowing them to join a health plan’s network.

Medi-Cal managed care plans

Health insurance programs for low-income individuals in California that are run by private companies under state supervision.

Limits and Unknowns

• The bill does not specify the exact penalties for violating these requirements.
• It is unclear how this change will affect health care providers and plans before January 1, 2028.

Official Summary Text

AB 2457, as introduced, Connolly.
Health care provider credentialing.
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 requires a full service health care service plan, excluding a Medi-Cal managed care plan, or its delegate, to subscribe to and use the Council for Affordable Quality Healthcare credentialing form on and after January 1, 2028. On and after January 1, 2027, existing law requires a health care service plan, excluding a Medi-Cal managed care plan, or its delegate, that credentials health care providers for its networks to make a determination regarding the credentials of a provider within 90 days after receiving a completed provider credentialing application.
This bill would extend the application of the
above-described requirements to Medi-Cal managed care plans. Because a willful violation of these requirements by a Medi-Cal managed care 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.

Current Bill Text

Download Bill PDF