SB 137 Implementation The Latest from Sacramento

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1 SB 137 Implementation The Latest from Sacramento April 13, 2017 Mary Watanabe Deputy Director, Health Policy and Stakeholder Relations Havi Jogani Attorney, Office of Plan Licensing

2 California Provider Directory Requirements Senate Bill 137 added California Health & Safety Code section (repealed section ) Uniform Provider Directory Standards Released: 12/30/2016; Compliance Date: 1/1/ pds.pdf For Medi-Cal Plans: 42 C.F.R (h)

3 Timeline Date Description July 1, 2016 Compliance date for SB 137 December 30, 2016 January 1, 2018 TBD January 1, 2021 Uniform Provider Directory Standards Released Compliance date for Uniform Provider Directory Standards Compliance date for SB 1135 (Timely Access to Care) Two revisions of provider directory standards and development of regulations Final regulations promulgated

4 Major Provisions Provider directories must be available online, updated weekly Directory inaccuracies can be reported for investigation by telephone, , and hyperlink Annual provider notification verification process Online interfaces for providers to easily verify or submit changes to provider directory information

5 Required Provider Information Provider s name Practice location(s) Contact information Type of practitioner National Provider Identifier number California license number and type of license Area of specialty, including board certification Provider s office address, if available Provider group affiliations Non-English languages spoken Panel Status (whether provider is accepting new patients) Network tier, if applicable

6 SB 137 Provider Requirements Providers must report to plans within 5 business days any change in panel status (whether a provider is accepting new patients) If a provider who is not accepting new patients is contacted by an enrollee or potential enrollee seeking to become a new patient, the provider shall: 1. Direct the enrollee or potential enrollee to the plan for additional assistance in finding a provider; and 2. Direct the enrollee to the DMHC to report any inaccuracy with the plan s provider directory. Providers must verify or submit changes to provider directory information using the process required by plans

7 Uniform Provider Directory Standards Directories must list a provider s licensed name (preferred names may be included) For full-service commercial health plans, all products must include product type and metal level, as applicable Parameters for display of panel status and provider s office address Directories must display the date of the most recent update

8 DMHC s Oversight of SB 137 Compliance Initial compliance filing Annual compliance filings Incorporating SB 137 compliance into DMHC s routine health plan survey process Monitor complaints to DMHC Help Center Enforcement action when necessary and appropriate

9 SB 137 Next Steps Monitor plan compliance with initial standards Continue to meet and engage with all stakeholders regarding proposed revisions to the uniform standards Issue further regulatory guidance on provider directories as necessary Overlap with other Legislation implementation

10 Related Activities SB 1135, Timely Access to Care Timely Access Compliance Reports Annual Network Review AB 72, Prohibition on Surprise Balance Billing Undertakings Related to Provider Directories

11 Questions Mary Watanabe Deputy Director Health Policy and Stakeholder Relations (916) Havi Jogani Attorney Office of Plan Licensing (916)