Bill Text: CA AB815 | 2023-2024 | Regular Session | Amended
Bill Title: Health care coverage: physician and provider credentials.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Engrossed - Dead) 2024-08-15 - In committee: Held under submission. [AB815 Detail]
Download: California-2023-AB815-Amended.html
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Amended
IN
Senate
July 03, 2024 |
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Amended
IN
Senate
June 17, 2024 |
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Amended
IN
Assembly
April 20, 2023 |
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Amended
IN
Assembly
March 13, 2023 |
CALIFORNIA LEGISLATURE—
2023–2024 REGULAR SESSION
Assembly Bill
No. 815
| Introduced by Assembly Member Wood |
February 13, 2023 |
An act to add Section 1374.198 to, and to add Chapter 7 (commencing with Section 1700) to Division 2 of, the Health and Safety Code, and to add Section 10144.58 to the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 815, as amended, Wood.
Health care coverage: physician and provider credentials.
Existing law establishes the California Health and Human Services Agency, which includes departments charged with the administration of health, social, and other human services. Existing law provides for the licensure and regulation of health care service plans by the Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act of 1975, and the regulation of health insurers by the Department of Insurance. Existing law sets forth requirements for provider credentialing by a health care service plan or health insurer. A violation of the requirements of the Knox-Keene Health Care Service Plan Act of 1975 by a health care service plan is a crime.
This bill would require the California Health and Human Services Agency to create and maintain a provider
physician credentialing board, with specified membership, and would require the board, on or before July 1, 2026, 2027, to develop a standardized credentialing form to be used by all health care service plans and health insurers. The bill would require every health care service plan and or health insurer to use the standardized credentialing form, as specified. The bill would prohibit a health care service plan or health insurer from requesting any additional information from a provider that is not required on the standardized credentialing form.
The bill would not apply the standardized form requirements to specified Medi-Cal managed care contracts with the State Department of Health Care Services.
Existing law, for provider contracts issued, amended, or renewed on and after January 1, 2023, requires a health care service plan or disability insurer that provides coverage for mental health and substance use disorders and that credentials health care providers of those services for its networks to assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application, and to notify the applicant within 7 business days of receipt of the application to verify receipt and inform the applicant whether the application is complete.
This bill, for provider contracts issued, amended, or renewed on and after January 1, 2026, would impose the same requirements on all health
care service plans and health insurers that credential health care providers for their networks.
Because violation of certain requirements of the bill by a health care service plan would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1374.198 is added to the Health and Safety Code, to read:1374.198.
SEC. 2.
Chapter 7 (commencing with Section 1700) is added to Division 2 of the Health and Safety Code, to read:
CHAPTER
7. Health Provider Physician Credentialing
1700.
For purposes of this chapter:(a) “Agency” means the California Health and Human Services Agency.
(b) “Board” means the provider physician credentialing board established pursuant to Section 1701.
(c) “Credentialing information” means information regarding a physician’s professional training, qualifications, background, practice history, and experience, including all of the following:
(1) Status of medical license.
(2) Clinical hospital privileges.
(3) Status of United States Drug Enforcement Administration certificate.
(4) Education, training, and board certification.
(5) Work history.
(6) Current malpractice coverage.
(7) History of professional liability or malpractice claims.
(8) Drug or alcohol abuse, to the extent permitted by law.
(9) History of board appearances.
(10) Loss, surrender, restriction, or suspension of license.
(11) Felony convictions.
(12) History of loss or limitation of privileges or disciplinary activity.
(13) Attestation of the correctness and completeness of the application.
(14) History of Medicare or Medicaid sanctions or other sanctions.
(15) Other objective information typically required by accrediting organizations for the purpose of credentialing physicians.
1701.
(a) The agency shall create and maintain a(1) Not less than ____ four
representatives of health care service plans and insurers, appointed by the Governor. insurers. Three representatives shall be appointed by the Governor, and one shall be appointed by the Senate Committee on Rules.
(2) Not less than ____ four representatives of physicians and surgeons, appointed by the Governor. surgeons. Three representatives shall be
appointed by the Governor, and one shall be appointed by the Speaker of the Assembly.
(3) The Secretary of California Health and Human Services or their designee.
(4) The Insurance Commissioner or their designee.
(5) The Director of Health Care Services or their designee.
(6) The Director of the Department of Managed Health Care or their designee.
(b) Members of the board shall not receive compensation or per diem for serving on the board.
1702.
The board shall do both of the following:(a) Review National Committee for Quality Assurance, Medicare, and Medicaid credentialing requirements and establish minimum standards or policies and processes that can streamline and reduce redundancy and delay in provider physician credentialing.
(b) (1) On or before July 1, 2026,
2027, develop a standardized credentialing form that shall be used by all health care service plans and health insurers. insurers for credentialing and recredentialing purposes. Notwithstanding any other law, on and after July 1, 2026, 2027, or six months after the form is completed pursuant to this section, whichever is later, every health care service plan and health insurer shall use that standardized credentialing form described in paragraph (2). A health care service plan or health insurer shall not request any additional information from a provider that is not required on the standardized credentialing form.
only be allowed to request additional information from a physician to clarify and confirm information that is provided on the standardized credentialing form. A health care service plan and health insurer shall minimize the number of requests for additional information from physicians.
(2) The standardized credentialing form developed pursuant to this subdivision shall meet the following criteria:
(A) The form shall be made electronically available by the departments, health care service plans, and health insurers.
(B) The completed form may also be electronically submitted from the provider
completed and submitted by the physician to the health care service plan or health insurer.
(3) The board shall develop the standardized credentialing form with input from interested parties from at least one public meeting.
(4) The board shall update the standardized credentialing form every three years. years, or as necessary to comply with changes in laws, regulations, and guidelines related to credentialing requirements.
(c) Subdivision (b) does not apply to contracts
with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
