CA Rule: Department of Insurance - Provider Network Adequacy

Title: Provider Network Adequacy

Agency:  Department of Insurance

Citation: Title 10, Ch. 5, Subpart 2, Section 2240.5

Summary:  This rule would strengthen requirements regarding network design, demonstration of insurer compliance, submission of data that will support the analysis of emerging trends, as well as requirements regarding accuracy of provider directories and other consumer notices.  Among other requirements, it requires insurers to file a network adequacy report with the Department of Insurance that provides a description of the implementation and use of triage, telemedicine and health information technology to provide timely access to care.  It also provides for a waiver of the network access standards.  An application for such a waiver must include an explanation of alternatives that were considered, including but not limited to telemedicine or phone consultations (among other requirements).

Status: 3/23/16 Adopted

Effective: 3/8/16

2016 Approved Leg./Reg.