Health care coverage: provider directories.

Assembly Member Aguiar-Curry's legislation tackles persistent inaccuracies in health care provider directories by establishing mandatory accuracy benchmarks and verification requirements for California health plans and insurers. The bill mandates that provider directories achieve 60% accuracy by July 2026, with incremental increases reaching 95% accuracy by July 2029.

The legislation requires health plans and insurers to verify directory information annually and remove inaccurate listings. Plans must reimburse enrollees for covered services when patients rely on incorrect directory information, with providers prohibited from charging beyond in-network cost-sharing amounts. The measure introduces administrative penalties ranging from $500 to $10,000 per 1,000 enrollees for plans failing to meet accuracy benchmarks.

To facilitate implementation, the Department of Managed Health Care and Department of Insurance may develop standardized formats for collecting provider information and establish processes to verify directory accuracy by January 2026. The departments can require plans to utilize central utilities for maintaining provider data, though plans demonstrating compliance through other means may receive exemptions.

The bill defines accuracy based on the percentage of provider listings containing correct information about location, contact details, network status, and other key data points. Plans must document verification efforts and publicly report accuracy rates. The legislation maintains existing requirements for weekly online directory updates and quarterly printed directory updates while adding new protections for consumers who rely on directory information when selecting providers.

For Medi-Cal managed care plans, the provisions apply to the extent consistent with federal requirements. The measure also requires plans contracting with multiple employer welfare agreements to meet the same directory accuracy standards.