Jones Releases Emergency Rule Over Narrow Provider Networks

On Monday, the California Department of Insurance issued an emergency regulation that aims to address narrow provider networks in the state and improve residents' access to care, Capital Public Radio's "KXJZ News" reports.

Jones announced the new regulation at his second-term inauguration (Moffit, "KXJZ News," Capital Public Radio, 1/5).

For more on the first day of the new legislative session, see today's "Capitol Desk" post.

Background

According to the state Department of Managed Health Care, several insurers, including Anthem, have violated state law by misleading consumers about the size of their provider networks (California Healthline, 11/19/14).

State Insurance Commissioner Dave Jones (D) said 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 ("KXJZ News," Capital Public Radio, 1/5);
• 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).