Plain English Breakdown
The source text mentions increasing accuracy benchmarks but does not list the exact percentages required between 2026 and 2029.
AB-280: Rules for Health Care Provider Directories
This law sets yearly accuracy goals for health insurance provider lists and requires plans to cover services if patients rely on wrong information in those lists.
What This Bill Does
- Requires health plans and insurers to check their provider directories every year and remove incorrect listings.
- Sets a goal of 60% directory accuracy by July 1, 2026, with increasing yearly goals until reaching 95% by July 1, 2029.
- Requires plans to pay for covered services if patients rely on inaccurate or misleading information in the directories and reimburses providers at out-of-network rates.
- Prohibits doctors from charging patients extra fees beyond standard cost-sharing when directory errors occur; these costs count toward deductibles and maximums.
- Requires plans to answer patient requests about whether a provider is accepting new patients within specific time limits.
- Authorizes state agencies to create uniform forms for collecting and checking provider information by January 1, 2026.
Who It Names or Affects
- Health care service plans regulated by the Department of Managed Health Care
- Health insurers regulated by the Department of Insurance
- Patients enrolled in these health coverage plans
- Medical providers listed in insurance directories
Terms To Know
- Provider directory
- A list published by an insurer showing which doctors and hospitals accept their plan.
- Cost sharing
- The portion of medical costs the patient must pay, such as copayments or deductibles.
- Out-of-network amount
- A higher payment rate used when a provider is not officially listed in the plan's directory.
Limits and Unknowns
- The bill does not specify the exact percentage accuracy required for each year between 2026 and 2029.
- Administrative penalties are mentioned but their specific dollar amounts or calculation methods are not detailed in this text.
- The effective date of the law is not listed in the provided source material.