By Zoe Bulls
On January 10, 2025, the Department of Managed Health Care (DMHC) published notice of proposed rulemaking to add section 1300.67.27 to title 28 of the California Code of Regulations (CCR) to clarify how health plans licensed to operate in California must update the provider directories shared with health plan enrollees. A provider directory is a list of medical professionals, hospitals, and other healthcare providers considered to be “in-network.” In-network healthcare entities provide lower-cost services to health plan enrollees compared to the cost of services provided by out-of-network healthcare entities.
According to the initial statement of reasons and proposed text, this regulation would clarify the requirements health plans must meet in creating provider directories. Existing law, codified by SB 137 (Hernandez) (Chapter 649, Statutes of 2017) and found in Health and Safety Code section 1367.27, provides standards for maintaining, updating, and creating provider directories and requires that health plans publish the provider directories on the health plan’s website. SB 137 also mandated DMHC to develop Uniform Provider Directory Standards in coordination with the California Department of Insurance.
The open and pending regulation would define key terms in existing provider directory requirements to assist health plans and the DMHC in ensuring that health plan enrollees have access to consistent and uniform provider directories. The proposed text seeks to define key terms, which include “accepting new patients,” “contact information,” “network,” and “telehealth provider,” among others. The rulemaking would further enumerate the requirements health plans must follow for updating their provider directories, including listing the date of the directory’s last update to the directory when changes are made and maintaining an archive of previous provider directories for five years. Generally, all provisions of the pending regulation seek to establish a consistent body of requirements in accordance with the Uniform Provider Directory Standards. According to the Department of Managed Health Care, this regulation will not have a fiscal impact on the state government or an economic impact on businesses in California.
DMHC is holding an open comment period from January 10, 2025, to February 24, 2025, during which the public can provide input on the proposed rulemaking measure.
DMHC was established and given regulatory authority over health plans operating in California by the Knox-Keene Health Care Service Plan Act of 1975. According to its 2023 Annual Report, DMHC licenses and regulates more than 95% of California commercial and public health plans and endeavors to protect consumers’ health care rights and foster a stable health care delivery system. Consumers experiencing coverage denials or other issues with their health plan can seek support from DMHC on its website.