An act to amend Section 1367.27 of the Health and Safety Code, and to amend Section 10133.15 of the Insurance Code, relating to health care coverage.
AB 280 would significantly tighten California’s rules for health plan and health insurer provider directories. It requires plans and insurers to regularly verify directory data, remove inaccurate listings, and meet escalating accuracy benchmarks over time, reaching 95% accuracy by July 1, 2029. The bill also expands what must be shown in directories, including provider contact details, specialties, languages, network tier information, whether a provider is accepting new patients, and other search fields, while requiring accessible online directories and printed copies on request.
The bill also creates stronger consumer protections when directory information is wrong. If a consumer reasonably relies on inaccurate, incomplete, or misleading directory information, the plan or insurer must cover the services as if they were in-network, hold the consumer harmless beyond in-network cost sharing, and reimburse the provider at the out-of-network rate. In addition, if a consumer asks whether a provider is in-network, the plan or insurer must respond promptly and confirm whether the provider is accepting new patients. The bill authorizes administrative penalties for failing to meet accuracy benchmarks and allows the Department of Managed Health Care and the Department of Insurance to develop standardized formats and methods for verifying directory information, including possible use of a central utility.
AB 280 would amend both Health and Safety Code Section 1367.27 and Insurance Code Section 10133.15, so it applies to health care service plans regulated by the Department of Managed Health Care and health insurers regulated by the Department of Insurance. It would also affect provider groups and contracting providers by requiring them to verify directory information, respond to plan notices, and update changes within specified timeframes. The bill includes special provisions for Medi-Cal managed care plans, multiple employer welfare arrangements, and certain specialized plans, and it preserves existing provider obligations under their contracts.
The general sentiment reflected in the bill’s legislative path appears supportive of the goal of improving directory accuracy and consumer access, as shown by strong committee and floor votes early in the process. At the same time, the bill was later placed on the suspense file and ultimately ordered to the inactive file at the request of Senator Durazo, suggesting unresolved fiscal, implementation, or policy concerns despite broad agreement on the underlying problem. The bill’s findings emphasize “ghost networks” and consumer harm, indicating a consumer-protection framing that likely drove much of the support.
The main points of contention appear to be the bill’s administrative burden and enforcement structure. The bill imposes detailed verification duties, potential payment delays for nonresponsive providers, escalating accuracy standards, and monetary penalties on plans and insurers, which could raise concerns among carriers and provider organizations about compliance costs, operational complexity, and the risk of over-removal from directories. Another likely issue is the use of a central utility and the department’s authority to define “actively contracting” or “actively participating,” which could affect how network adequacy is measured and how providers are counted in directories and marketing materials.
AB 280 would revise California’s health plan and health insurer directory statutes by imposing new verification, update, disclosure, and accuracy requirements on provider directories. It would create enforceable accuracy benchmarks, authorize administrative penalties for noncompliance, require prompt correction of reported errors, and require coverage and reimbursement protections when consumers rely on inaccurate directory information. The bill would also expand regulatory authority for DMHC and DOI to standardize directory data collection and potentially require use of a central utility, while affecting related provider contract terms, payment timing, and network adequacy reporting.
The bill appears to have broad policy support around the goal of reducing inaccurate provider directories and ghost networks, as reflected in strong committee and floor votes. However, its later movement to the suspense file and then the inactive file suggests that, despite general agreement on the problem, there were unresolved concerns about cost, implementation, and the scope of regulatory and enforcement changes. Overall, the sentiment is best characterized as favorable to the bill’s consumer-protection aims but cautious about its operational and fiscal implications.
The most notable contention centers on how aggressively the state should police directory accuracy and who should bear the compliance burden. Health plans and insurers would face new benchmark-based penalties, mandatory verification processes, and possible payment delays tied to provider nonresponse, while providers and provider groups would be required to repeatedly verify information and could be removed from directories if they do not respond. There may also be disagreement over the bill’s definition of “actively contracting/participating,” the use of a central utility, and whether the new rules could inadvertently reduce network listings or create administrative friction for providers, especially in rural or specialized settings.