Zelis Legislative Watch: Hawaiian Bill Becomes Latest Network Access and Adequacy Law

The governor of Hawaii had until last week to say what bills passed by the state legislature he intended to veto. Hawaii Senate Bill 387 was not on the governor’s veto list; as such, Hawaii has become one of a growing number of states with expansive provider network access and adequacy laws, which all include provisions regarding accurate provider directories.

The Hawaiian law includes:

• Adequacy requirements: The state shall determine whether networks are “sufficient in numbers and appropriate types of providers” for plan filings made in 2018;
• Contract requirements for providers and intermediaries: effective July 1, 2017 for new contracts signed thereafter; effective January 1, 2019 for existing contracts;
• Notifications of provider selection standards and processes for a provider leaving a network;
• Provider directory requirements, including directory updates at least monthly (similar to Georgia’s requirement) and periodic audits of a reasonable sample size of providers (similar to Maryland’s requirement.)

There are now 28 states with laws or regulations regarding provider directories.

Illinois House Bill 311 is another expansive access and adequacy bill. It has passed out of the state legislature and is expected to be signed by the governor soon.

Zelis is always listening – to our clients’ needs and to marketplace dynamics. We continue to monitor healthcare laws and bills so that we can help you understand specific requirements at the state level and the impact those requirements could have on your business.