HB5395: NETWORK ADEQUACY-STANDARDS

Legislative Summary

Reinserts the provisions of the engrossed bill with changes that include the following. Requires the issuer of a network plan to submit a self-audit of its provider directory and a summary to the Department of Insurance, which the Department shall make publicly available. Makes changes to the information that must be provided in a network plan directory. Sets forth required actions if an issuer or the Department identifies a provider incorrectly listed in the provider directory. Removes provisions repealing the Short-Term, Limited-Duration Health Insurance Coverage Act and the related changes. Makes changes to provisions concerning confidentiality; transition of services; unreasonable and inadequate rates; the definitions of "excepted benefits" and "step therapy requirement"; off-formulary exception requests; algorithmic automated review processes; utilization review criteria; and adverse determinations. Makes other changes. Effective January 1, 2025, except that certain changes to the Managed Care Reform and Patient Rights Act take effect January 1, 2026.