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 787 would update California’s provider directory rules for health care service plans and health insurers. The bill requires directories to include a prominent notice telling enrollees and insureds to contact the plan or insurer for help finding an in-network provider and for an explanation of out-of-network coverage rights. It also requires the notice to explain that requests may be marked urgent or nonurgent, and it sets response deadlines for the plan or insurer: acknowledgment within one business day, and search results within two business days for urgent requests or five business days for nonurgent requests.
The bill also strengthens directory accuracy requirements. Plans and insurers would have to keep online and printed directories updated on a regular schedule, include more detailed provider information, and maintain processes for providers and the public to report inaccuracies. Providers would be required to notify plans or insurers within five business days when they stop accepting new patients or resume accepting them. If a directory error is reported, the plan or insurer must investigate promptly and correct the information within 30 business days. The bill also allows plans and insurers, in limited circumstances, to delay payment to providers who fail to respond to verification requests, and it authorizes regulators to require coverage or reimbursement when a consumer reasonably relied on materially inaccurate directory information.
AB 787 would amend Section 1367.27 of the Health and Safety Code and Section 10133.15 of the Insurance Code, so it would affect both Knox-Keene health care service plans regulated by the Department of Managed Health Care and health insurers regulated by the Department of Insurance. It would impose new operational and compliance duties on plans, insurers, provider groups, and contracted providers, while also requiring the departments to review compliance and develop or use uniform provider directory standards. The bill also applies, with some limitations, to Medi-Cal managed care plans and multiple employer welfare arrangements.
The overall sentiment reflected in the bill’s legislative history appears strongly favorable. The bill received unanimous “do pass” votes in committee and passed the Assembly 77-0, suggesting broad support for improving provider directory accuracy and consumer access to network information. The bill was later amended in the Senate and advanced again without recorded opposition in committee votes.
The main points of contention appear to be administrative burden, compliance costs, and enforcement mechanics rather than the policy goal itself. The bill adds detailed update, verification, notice, and documentation requirements for plans and insurers, and it creates payment-delay tools that may be viewed as burdensome by providers. It also includes a state-mandated local program finding and a no-reimbursement clause, indicating sensitivity to fiscal and mandate issues. The bill was ultimately placed on the suspense file and held under submission, which suggests fiscal or procedural concerns remained even though the policy itself drew little overt opposition.
AB 787 would expand and tighten California’s provider directory disclosure and accuracy requirements for health care service plans and health insurers under the Health and Safety Code and Insurance Code. It would require more prominent consumer notices, faster response times to help requests, more detailed provider listings, routine verification by providers, and stronger correction procedures when directory information is inaccurate. It also gives regulators authority to require coverage or reimbursement when consumers rely on materially inaccurate directory information, and it adds compliance review duties for the Department of Managed Health Care and the Department of Insurance. The bill would affect plans, insurers, provider groups, and contracted providers, including certain Medi-Cal managed care plans and MEWAs, while also creating a limited payment-delay mechanism for nonresponsive providers.
The bill appears to have been received positively overall, with unanimous committee votes and a 77-0 Assembly floor vote indicating broad bipartisan support for improving provider directory accuracy and consumer access to in-network care. The available voting history shows no recorded opposition in the votes provided. Its later placement on suspense and being held under submission suggests that fiscal or implementation concerns may have slowed final advancement, but the policy direction itself appears largely uncontroversial.
The main concerns are likely practical and fiscal rather than ideological. Plans and insurers would face new obligations to update directories, verify provider status, document investigations, and respond quickly to consumer requests, which could increase administrative workload and compliance costs. Providers and provider groups may also object to the bill’s verification requirements and the possibility of delayed payment or reimbursement if they do not respond to directory audits. Another likely point of concern is the bill’s enforcement structure, including regulator authority to require coverage or reimbursement based on inaccurate directory information and the state-mandated local program implications, even though the bill states no reimbursement is required.