Zelis has illustrated, by color, the states that have statutes, regulations, or sub-regulatory requirements around insurers’ provider network directories.
Laws, regulations, or sub-regulatory requirements on insurers’ provider directories have now been adopted in 29 states, plus the District of Columbia. The latest laws came out of Hawaii (HI SB 387) and Maine (ME LD 1557), which both passed provider directory bills laws in June. Maine’s law may have escaped notice since its title seemed to indicate that the provisions would only be about balanced billing.
One we’re still waiting on: A broad-scope provider directory bill (IL HB 311) was just sent to the Illinois governor for his signature.
Of the 29 states with rules, some of these state provider directory rules focus only on directory requirements, while others are more broad in scope and include balance billing requirements, access and availability requirements, new filing requirements, and provider contract requirements.
The bellwether of all provider directory laws – broad in its scope and extent of requirements – was California’s SB 137 passed in late 2015 and its subsequent regulations. In 2016, we saw Georgia and Maryland pass laws that looked similar to California in scope, if not their specific requirements. And in 2017, the Hawaiian law and the potential Illinois law follow in California’s footsteps, though their requirements are not as extensive.
In 2017, other states adopted directory laws that only added a few directory requirements. For example, Colorado passed a relatively small-scope directory law (CO SB 1165) this year requiring the removal of providers from directories whose licenses have been revoked or suspended. Connecticut added a single requirement in CT SB 546 that the directories had to indicate whether a provider is accepting new patients.
A few states are still in session or have continual sessions, so we may yet see directory bills coming out of Massachusetts, New Jersey, or others.
Zelis is always listening – to our clients’ needs and to marketplace dynamics. We continue to monitor healthcare laws and bills so that we can help you understand specific requirements at the state level and the impact those requirements could have on your business.