Emergency regulation requiring health insurers to have sufficient medical providers goes into effect immediately

California’s Insurance Commissioner Dave Jones issued an emergency regulation to establish stronger requirements for health insurers to create and maintain sufficient medical provider networks and to provide timely access to medical care. The emergency regulations strengthen current rules and regulations and add new medical provider network requirements that require insurers to, among other things, include an adequate number of primary care physicians accepting new patients, an adequate number of primary care physicians with admitting privileges at network hospitals, build a network capable of the treatment of mental health and substance use disorders, adhere to appointment waiting time standards, and require network facilities to inform patients if an out-of-network provider will participate in non-emergency procedure or care, before the care is provided, so that the patient has an opportunity to decline the provider’s participation. Patients have been surprised by huge bills from out-of-network doctors who were included in their treatment without notice or consent of the patient. Jones says if an insurance company does not comply with the new regulations, he can deny them the ability to sell insurance next year. The California Hospital Association (CHA), representing over 400 hospitals and health systems, objects to certain provisions of these regulations on the grounds that no emergency exists, there is no statutory authority and the regulations are ambiguous. The state legislature in New York has passed the new “Surprise Bill” health insurance law which requires that all health plans that are based on comprehensive provider networks; PPO and EPO be certified as having provider networks that can meet the health needs of their members without having to rely on the more expensive out-of-network services. This law takes effect April 1, 2015.