New California Law Increases Oversight of Medi-Cal Provider Networks

Gov. Jerry Brown has signed legislation to boost oversight of so-called “narrow networks” and other business practices that affect timely access to care.

Senate Bill 964 by state Sen. Ed Hernandez requires the California Department of Managed Health Care to review Medi-Cal managed-care plans and plans sold through Covered California annually for compliance with standards related to timely access, network adequacy, continuity of care and quality management.

Consumer groups supported the measure; health plans said it wasn’t necessary.

In a year where more than 1 million mostly uninsured Californians signed up for coverage, many patients found it difficult to find a doctor or get an appointment in a timely way. The managed care agency received more than 300 complaints from Covered California enrollees who had problems from Jan. 1 through Aug. 31. The agency is studying the issue and expects to issue reports before open enrollment starts Nov. 15.

“SB 964 will increase oversight and enforcement of insurers so people can get the care they need where and when they need it,” Anthony Wright, executive director of bill sponsor Health Access, said in a statement when lawmakers approved the bill. Once signed, he described the bill as the new law “with perhaps the most direct impact on the biggest number of consumers.”

State regulators already review plans for timely access and network adequacy — and the bill imposes new reporting requirements that are expensive and unnecessary, countered Charles Bacchi, executive vice president at the California Association of Health Plans.

Other legislative efforts to tackle the issue fizzled. The most controversial was Assembly Bill 2533 by Assemblyman Tom Ammiano, which would have allowed consumers to go out of network if they have to in order to get timely care — and pay as if the provider was in the network.

The bill would destroy years of managed-care policy that attempts to channel patients into cost-effective care, Bacchi said. The bill died on the Senate floor in mid-August.

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