Health care coverage: provider directories.

Assembly Member Aguiar-Curry's legislation aims to strengthen the accuracy of healthcare provider directories through a series of graduated benchmarks and enhanced consumer protections. The bill requires health plans and insurers to verify their provider directories annually, with accuracy rates increasing from 60% in 2026 to 95% by 2029.

The measure establishes clear standards for directory maintenance, requiring plans to update online listings weekly and printed directories quarterly. Plans must verify provider information annually and promptly remove inaccurate listings. When consumers rely on incorrect directory information, plans must cover services at in-network rates and protect patients from additional charges beyond standard cost-sharing amounts.

To ensure compliance, the legislation authorizes administrative penalties for plans failing to meet accuracy benchmarks. The Departments of Managed Health Care and Insurance will develop uniform standards for directory formats and may require plans to use centralized systems for maintaining provider information. Plans must also respond within two business days to consumer inquiries about provider network status and availability to accept new patients.

The bill includes specific protections for tiered networks, requiring plans to document and disclose provider cost-sharing tiers accurately. If plans incorrectly indicate a provider is in a lower-cost tier, patients are only responsible for the lower tier's cost-sharing amount. These provisions aim to prevent consumers from facing unexpected costs due to directory errors.