Assembly Majority Leader Aguiar-Curry Seeks to Ensure Accurate Health Plan Provider Directories

For immediate release:

• Gibson Martucci
• 916-319-3104
• [email protected]

SACRAMENTO, CA - Yesterday, Assembly Majority Leader Cecilia Aguiar-Curry (D-Winters) introduced Assembly Bill 280, to improve the accuracy of health plan provider directories and make it easier for Californians to access the care they need.

Under existing California law, health plans are required to maintain accurate and up-to-date directories of in-network healthcare providers. However, enforcement of this law has been inadequate, leading to widespread inaccuracies in directories. Consumers frequently encounter providers who are unreachable, unavailable, or no longer accepting patients, creating significant barriers to timely care. Since 2016, the Department of Managed Health Care (DMHC) has taken only five enforcement actions against health plans, with fines too small and infrequent to drive meaningful change.

"When people sign up for a health plan, they should be able to reasonably expect that most of the health professionals on the list are available to provide care. People should be able to trust their health plan directories to have doctors and mental health professionals who can give them the care they need in the time they need it," said Majority Leader Cecilia Aguiar-Curry. "This bill will make sure that when you're shopping for a health plan, you're not basing your decision on a 'medical mirage,' a list of providers who are out of business or not taking patients."

These inaccurate provider directories disproportionately affect people in marginalized communities, including those with limited English proficiency and people with disabilities. Error rates are high among directories for mental health providers and psychiatrists and primary and specialty care providers. One health plan was found to have an error rate of 80 percent for psychiatrists, with most having error rates of 20-30 percent.

"Patients shouldn't have to navigate a maze of incorrect information just to find someone to treat them," Aguiar-Curry emphasized. "This legislation provides a roadmap to improve transparency and accountability, making our healthcare system work better for everyone."

Under AB 280, health plans will be required to comply with annual verifications of provider information and comply with accuracy benchmarks or incur penalties, all to enhance consumer protections. Health plans will be required to verify provider information annually by following standards set by DMHC and the California Department of Insurance (CDI). The bill also establishes progressive accuracy benchmarks for provider directories, starting at 60 percent accuracy and reaching 95 percent by 2029. Penalties will be imposed on plans that fail to meet accuracy standards, ensuring greater accountability. DMHC and CDI will be empowered to mandate the use of a third-party central provider directory utility, streamlining the updating process for provider information. When consumers rely on inaccurate directory information, health plans will be required to arrange care and cover out-of-network costs associated with the error.

"Health plan provider directories are crucial for consumers to find the care they need in their network, but these listings are often so grossly inaccurate. It's difficult, or nearly impossible, for someone to find that care," said Katie Van Deynze, senior policy and legislative advocate with Health Access California. "This leads to delays in needed care which can worsen existing health conditions. AB 280 puts health plans on a path of improvement, and holds them accountable to keep these directories up-to-date for consumers, so they can find care."

AB 280 is part of a broader effort to address healthcare inequities and ensure all Californians, regardless of their background or circumstances, may access the care they need without unnecessary delays or confusion.

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Assemblymember Cecilia Aguiar-Curry represents California's 4th Assembly District, which includes all of Lake, Colusa, Napa, and Yolo Counties, and part of Sonoma County. She serves as the Assembly Majority Leader and Chair of the California Women's Legislative Caucus.