During his inauguration ceremony on Monday, January 5th, California Department of Insurance Commissioner Dave Jones issued an emergency regulation requiring health insurers to have sufficient medical providers (i.e. adequate networks) to provide patients timely access to care. After a brief comment period, these regulations became effective immediately as of Monday, February 2, 2015. These emergency regulations expire on Thursday, July 30, 2015. Reissuance of the regulations must occur before the end of July. In reissuing the regulations, Commissioner Jones can amend, add or delete any current provisions.
In signing the executive order issuing the regulations, Commissioner Jones stated: “This emergency regulation is necessary to make sure that health insurers establish and maintain adequate medical provider networks to meet the health care needs of their policyholders, to make sure medical provider directories are accurate, and to stop the practice of surprising consumers with huge charges for out-of-network providers who provide care without the patients’ consent or foreknowledge.”
Although there are many beneficial elements in the regulations for surgery centers, there are also a couple provisions of concern. Principally, is new language being added to contacts with network providers under Title 10 California Code of Regulation section 2240.4(b)(6) on the terms of contracts between facilities and insurers to require they:
“… contain a provision requiring that network facilities shall determine and disclose to the insured person prior to an insured person’s non-emergency episode of care the non-network providers who are likely to be involved in providing care, and the estimated cost of that non-network care to the insured person. For example, for surgery and a network hospital, the hospital shall disclose to the insured person, prior to the surgery, all non-network providers, such as anesthesiologists, radiologists, and pathologists, who are anticipated to be involved in the insured persons care, and the estimated cost of their non-network services. This disclosure is to be made sufficiently in advance of the scheduled episode of care to afford the insured person a reasonable opportunity to explore alternative alternate arrangements.”
At this time and until further notice, all ASCs should assure that they are providing the appropriate information to their patients regarding providers and the care patients will receive, from those that are outside of the patient’s network.
CASA worked closely with California Medical Association on their written comments, which address CASA concerns by asking the disclosure provisions referenced above be deleted. Other hospital based medical specialties (i.e. anesthesiology, radiology, pathology, etc.) have similar concerns. The California Hospital Association is also opposed to the facility disclosure provisions. CASA successfully dealt with this issue in the Legislature in 2013 and will continue to seek deletion of the disclosure provisions or work with Commissioner Jones and other stakeholders to devise alternative language that protects the patient and the facility.