California Commissioner Issues Emergency Regulation Over Narrow Provider Networks

 

At his January 5 inauguration ceremony, California's Insurance Commissioner Dave Jones issued an emergency regulation to establish stronger requirements for health insurers to create and maintain sufficient medical provider networks to provide timely access to medical care.

Commissioner Jones (D) said Department of Insurance (DOI) has "received complaints from consumers across the state about long waiting times, about inaccurate directories of providers, about being charged out-of-network costs when there isn't an in-network provider. The list goes on and on and on" ("KXJZ News," Capital Public Radio, 1/5).

Details of Emergency Regulation

The emergency regulation requires insurers to:

  • Adhere to new standards for appointment wait times (DOI release, 1/5);
  • Offer an adequate number of physicians, clinics and hospitals to patients who live in certain areas;
  • Provide an accurate list of in-network providers
  • Provide out-of-network care options for the same price as in-network care when the number of in-network providers is insufficient; and
  • Report to DOI information about their networks and any changes.

The emergency regulation will go into effect after it has been reviewed by the Office of Administrative Law. According to a release, emergency regulations often go into effect more quickly than standard regulations (DOI release, 1/5).

According to Jones, he can bar insurers that do not comply with the regulation from selling insurance in the state next year ("KXJZ News," Capital Public Radio, 1/5).