Legislature passes bill that would require annual reports from insurers on provider network adequacy

September 04, 2014

The legislature has passed a bill that would require Medi-Cal managed plans and insurers offering individual plans through Covered California to provide annual reports to the California Department of Managed Health Care (DMHC) about the adequacy of their provider networks. The bill also requires DMHC to post annual reviews regarding plan compliance on its website.  

This California Medical Association (CMA) supported the bill, SB 964 (Hernandez), which passed late last week and is now on the governor's desk awaiting his signature.  

With roughly 1.4 million Californians newly enrolled in Covered California products since October of last year, the importance of adequate provider networks has been paramount. The new insurance products with narrowed networks, however, have made it  exceedingly difficult for both physicians and patients to find out who is in and out of these networks.

Network adequacy is key to implementing the Affordable Care Act (ACA) in the state and fulfilling the promise of health care coverage for all California citizens — yet coverage means little without access to in-network providers. Two surveys conducted by the California physician community suggest that Californians may still have difficulties with the access component of this health care promise.

First, a CMA survey conducted this spring, which resulted in an unprecedented response from over 2,300 physicians in less than two days, found that more than half of respondents have experienced difficulty finding an in-network physician or facility to which they can refer their Covered California patients.

Second, a Humboldt-Del Norte County Medical Society survey found that two-thirds of the listings in Anthem Blue Cross’s family practice physician directory in Humboldt County are inaccurate and that roughly three-quarters of the directory listings would not connect a consumer to a physician accepting new Covered California patients. 

There have also been several lawsuits filed by consumers against insurers for deceptive provider directories, and the state legislature has requested an audit of the Department of Health Care Services’ Medi-Cal provider directories for inaccuracies.

As these surveys and lawsuits suggest, network adequacy standards do not protect patients unless compliance is being sufficiently monitored and enforcement is enough to ensure access to care. While this bill is another positive step towards ensuring patients have adequate networks and accurate provider directories, CMA also believes that it is critically important that the state gives regulators the resources they need to enforce the network standards that are already on the books.

CMA hopes to continue working with state partners and fellow stakeholders to ensure that Californians will have coverage that translates to access going forward.


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