HB 5395 Summary: Network Adequacy and Transparency Act

• Strengthens network adequacy standards for health insurance plans by requiring minimum provider-to-beneficiary ratios, travel time/distance standards, and appointment wait times aligned with federal Centers for Medicare and Medicaid Services standards.

• Requires health insurance issuers to maintain accurate, searchable provider directories updated within 2 business days of provider notifications; imposes $5,000 per month penalties for failure to update directories and $25,000 per violation for knowingly listing incorrect providers.

• Expands mental health and substance use disorder coverage protections including specific travel time/distance and appointment wait time standards (30 minutes/miles in metropolitan counties; 60 minutes/miles elsewhere), with no prior authorization requirements for certain inpatient mental health treatments.

• Prohibits step therapy requirements starting January 1, 2026, and establishes a uniform electronic provider directory information form to standardize how providers submit information to insurers by July 1, 2026.

• Requires the Department of Insurance to adopt emergency rulemaking for federal provider adequacy standards and allows the Director to prohibit inadequate network plans from being issued or renewed in specific counties, with fines of $5,000 per noncompliant policy.