CA AB 1041

Title: Health care coverage: health care provider credentials.
Author: Steve Bennett

Summary
AB 1041, as amended, Bennett. Health care coverage: health care provider credentials. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance.This bill would require those departments to adopt specified credentialing requirements and adopt regulations to establish minimum standards or policies and processes that can streamline and reduce redundancy and delay in provider credentialing. The bill would also require those departments to adopt regulations to adopt, on or before January 1, 2028, the National Committee for Quality Assurance standardized credentialing form to be used by full service health care service plans and health insurers and their designees for credentialing and recredentialing purposes. The bill would require every full service health care service plan or health insurer or their designees to use the standardized credentialing form on and after January 1, 2028, or six months after the form is adopted, whichever is later. The bill would require those departments to update the form every three years, or as necessary to comply with changes in laws, regulations, and guidelines, as specified.Existing law requires a health care service plan or disability insurer that provides coverage for mental health and substance use disorders and that credentials health care providers of those services for its networks to assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application.This bill would, except as provided above, require every health care service plan or health insurer or their designees that credential health care providers for their networks to approve the credentials of a provider within 90 days after receiving a completed provider credentialing application. The bill would require every health care service plan or health insurer or their designees to activate the provider upon successful approval and notify the applicant of the activation, as specified. If the health care service plan or health insurer or their designees do not meet the 90-day requirement, the bill would require the applicant’s credentials to be conditionally approved for 120 days unless specified circumstances apply, including that the applicant is subject to discipline by the licensing entity for that applicant.Because a willful violation of these provisions by a health care service plan would be a crime, this bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.

Status
Read second time. Ordered to third reading.

Bill Documents
CA AB 1041 - 05/23/25 - Amended Assembly
05/23/25 - CA AB 1041 (05/23/25 - Amended Assembly)