CaliforniaHealth plans would check provider listings through a shared utility
Health plans and insurers would check provider listings through a shared utility, and people misled by materially wrong listings could owe only in-network cost sharing for covered care.
What it does
Health plans and insurers would use a shared utility to check provider listings for missing or conflicting information. The utility would prepare a report for each directory.
If the department finds someone reasonably relied on materially wrong directory information for covered care, the plan or insurer must cover the care and pay the provider. The person owes only in-network cost sharing.
Plans and insurers must check a request to restore a removed provider and approve it within 10 business days if the information is accurate.
A plan or insurer may warn readers that a provider has not confirmed a directory listing within five calendar days and the information may be out of date.
Argument forPeople who relied on wrong directory information could receive covered care at in-network cost sharing, limiting unexpected bills for out-of-network care.
Argument againstPlans and insurers may face extra work to send directory data to a central utility and review reports, which could take staff time from other tasks.
More detail
The Department of Managed Health Care must select a central utility and set shared directory rules. Plans and insurers must use the utility to check provider listings and report inconsistencies. The requirements cover health care service plans and health insurers subject to the provider-directory laws. A nonprofit plan or insurer meeting the stated size and exclusive-network conditions is exempt for providers serving only that plan, insurer, or affiliated group; the utility requirement still applies to providers serving more than one plan or insurer. Plans and insurers must comply beginning July 1, 2027. Insurers must update their procedures within 12 months after the department designates the utility.
When a department finds that an enrollee or insured reasonably relied on materially wrong, incomplete, or misleading directory information, the plan or insurer must cover the covered services and pay the provider. This applies to enrollees and insureds who relied on materially inaccurate, incomplete, or misleading provider directory information. The department must find reasonable reliance and confirm that the services were covered under the person’s plan or policy. The person owes only the applicable in-network cost sharing; that amount counts toward the in-network deductible and out-of-pocket maximum. The provider may not collect more from the person. The plan or insurer pays the agreed amount or, if there is no agreement, the usual reasonable amount for similar services in the area, minus the person’s in-network cost share.
Plans and insurers must check requests to restore providers who were removed from directories and approve accurate requests within 10 business days. This applies when a health plan or insurer receives a request to restore a provider previously removed from its directory. The plan or insurer must first ensure the required provider information is accurate. The 10-business-day period starts when the plan or insurer receives the request.
A plan or insurer may add a notice to a provider’s listing if the provider does not respond within five calendar days to the annual directory notice. This applies to providers who receive an annual directory notice and do not respond within five calendar days. The listing may say the provider is in-network as of the last directory update but has not verified the listing, so its information may be out of date. This is optional and does not itself remove the provider from the directory. The warning may appear before the provider is removed from the directory.
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Where it stands
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Sep 27Chaptered by Secretary of State - Chapter 499, Statutes of 2026.Latest
- Sep 27Approved by the Governor Gavin Newsom.Became Law
- Sep 4Enrolled and presented to the Governor at 4 p.m.To Governor
- Aug 27Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 64. Noes 2. Page 6696.).Major
- Vote recorded AB 280 Aguiar-Curry Concurrence in Senate Amendments. Result: pass.Lower
- Aug 27In Assembly. Concurrence in Senate amendments pending.
- Aug 26Read third time. Passed. Ordered to the Assembly. (Ayes 31. Noes 3.).Passed Senate
- Vote recorded 3rd Reading AB280 Aguiar-Curry et al. By Padilla. Result: pass.Upper
- Aug 24Read second time. Ordered to third reading.Minor
- Aug 21Read second time and amended. Ordered returned to second reading.Major
- Aug 21Ordered to second reading.Minor
- Aug 21From inactive file.
- 2025
- Sep 8Ordered to inactive file at the request of Senator Durazo.
- Aug 29Read second time. Ordered to third reading.Minor
- Vote recorded Do pass. Result: pass.Upper
- Aug 29From committee: Do pass. (Ayes 5. Noes 0.) (August 29).Minor
- Aug 18In committee: Referred to suspense file.Minor
- Vote recorded Placed on suspense file. Result: pass.Upper
- Jul 15Read second time and amended. Re-referred to Com. on APPR.Major
- Jul 14From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 8. Noes 0.) (July 9).Major
- Jul 9
- Vote recorded Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations]. Result: pass.Upper
- Jun 30From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.Major
- Jun 11Referred to Com. on HEALTH.Minor
- Jun 3In Senate. Read first time. To Com. on RLS. for assignment.Minor
- Vote recorded AB 280 Aguiar-Curry Assembly Third Reading. Result: pass.Lower
- Jun 2Read third time. Passed. Ordered to the Senate. (Ayes 61. Noes 7. Page 1926.)Passed Assembly
- May 27Read second time. Ordered to third reading.Minor
- May 23Read second time and amended. Ordered returned to second reading.Major
- Vote recorded Do pass as amended. Result: pass.Lower
- May 23From committee: Amend, and do pass as amended. (Ayes 11. Noes 1.) (May 23).Major
- May 23Assembly Rule 63 suspended. (Ayes 51. Noes 16. Page 1644.)
- Apr 23In committee: Set, first hearing. Referred to suspense file.Minor
- Apr 2From committee: Do pass and re-refer to Com. on APPR. (Ayes 11. Noes 0.) (April 1). Re-referred to Com. on APPR.Minor
- Apr 1
- Vote recorded Do pass and be re-referred to the Committee on [Appropriations]. Result: pass.Lower
- Feb 10Referred to Com. on HEALTH.Minor
- Jan 22From printer. May be heard in committee February 21.
- Jan 21Read first time. To print.Introduced
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