HF 551 Summary

• Health maintenance organizations, health carriers, and preferred provider organizations must apply for waivers of network adequacy requirements with $1,000 per county application fees, demonstrating infeasibility with specific data and steps to address network inadequacy.

• Waivers automatically expire after four years and cannot be renewed; subsequent applications must provide evidence of steps taken to address network inadequacy during the previous four-year period.

• Health maintenance organizations and carriers must post provider networks on websites and update monthly with changes, including transitions from in-network to out-of-network status, and list current waivers in easily searchable format.

• Commissioner must impose administrative penalties of at least a specified amount per day for violations of network adequacy requirements and establish a complaint process and investigation program to examine provider network compliance.

• Managed care and county-based purchasing plans must comply with appointment wait time standards: 45 days for routine primary care (24 hours for urgent), specialty care per community standards, and 60 days for dental/optometry/lab/x-ray regular appointments (48 hours for urgent).