SB1365 Summary

• Expands health benefit plan credentialing requirements to include mental health and substance abuse agencies and programs, not just individual healthcare providers.

• Requires health benefit plans to provide credentialing criteria information to applicants and participating providers/agencies, including a checklist of required materials.

• Establishes timelines for credentialing: 45 calendar days for "clean applications," up to 180 calendar days maximum; plans must notify applicants of incomplete applications within 10 days.

• Directs the State Board of Health to promulgate rules and develop a uniform credentialing application form by January 1, 2015, covering hospitals, managed care organizations, and five types of mental health/substance abuse entities.

• Prohibits health benefit plans from denying applications solely based on lack of board certification and from adding new requirements to delay applications; violations subject to administrative penalties by the Insurance Commissioner.