Provider directory disclosures.

Assembly Member Papan's provider directory legislation requires health plans and insurers to enhance their provider directories with prominent advisories about finding in-network providers and understanding out-of-network coverage rights. The bill establishes specific response timelines, mandating that plans acknowledge enrollee requests for provider information within one business day and furnish verified lists of available in-network providers within two business days for urgent requests and five business days for non-urgent inquiries.

The legislation institutes new verification protocols requiring plans to confirm provider availability annually or semi-annually, with potential payment delays or directory removal for non-responsive providers. Plans must maintain online interfaces for providers to verify and update their information, while also establishing dedicated channels for enrollees and the public to report directory inaccuracies. Provider directories must clearly display contact information for reporting errors and include disclosures about language interpretation services and disability access.

Under the bill's enforcement provisions, violations by health plans constitute crimes under existing law. Plans and insurers may delay provider payments or terminate contracts for repeated failures to maintain accurate directory information. The Department of Managed Health Care and Department of Insurance will incorporate directory compliance reviews into their routine examinations of plans and insurers, though the legislation requires no state reimbursement to local agencies for enforcement costs.