AB-280 Health care coverage: provider directories
Sep 20, 2026 edition · GC-2026-0056 · Published 2026-09-20 · Version 2 · Proposed
Pending AB 280 proposes a central provider-directory utility, common standards and reasonable-reliance protections, with specific integrated-plan and Medi-Cal scope exceptions.
What happened
AB 280 would require DMHC to select a central provider-directory utility and develop uniform standards for plans’ and insurers’ use of it to collect, manage and check directory completeness and consistency. Directories would be submitted for analysis and consistency reports, with provider-contract provisions supporting information updates and identification of the products in which the provider participates. The proposed compliance date is July 1, 2027. This is a pending proposal at the coverage cutoff, not evidence that a utility has already been selected or that a particular directory has been validated. The proposed utility rule has a specific exception for nonprofit plans with at least 3.5 million enrollees using a mutually exclusive single-medical-group geographic model: exclusively served or employed providers are exempt, while network providers contracting with more than one plan still use the utility. The AB 280 additions and amendments do not apply to the specified Medi-Cal managed-care contracts.
The bill would require coverage of covered benefits when an enrollee reasonably relied on inaccurate, incomplete or misleading directory information, with provider reimbursement at an agreed amount or, absent agreement, a reasonable and customary amount. The provider could not collect more than applicable in-network cost sharing, which would count toward in-network limits. It also addresses accurate restoration of removed listings within ten business days and a specified notice before removal following nonresponse. Directory accuracy, reasonable-reliance claims and provider participation data need coordinated review; the proposal does not make an inaccurate listing a promise of unlimited coverage for otherwise excluded benefits.
Scope and timing
- Authority status
- Proposed
- Applicability
- Potentially applicable
- Audience
- Health systems, Provider networks
- Jurisdiction
- California
- Affected functions
- Managed Care, Provider Enrollment, IT, Compliance, Legal
- Responsible owner
- Managed Care
Why it matters
Directory data can affect access, member cost sharing and provider reimbursement, not just website search results. The proposed utility adds another operational dependency.
Recommended action
Inventory directory data feeds and product-level participation records, identify reasonable-reliance complaint handling and assess readiness for a designated utility. Track the pending measure before changing coverage or payment rules.
Sources
- AB280 proposed bill text, historical selected versionOfficial · California Legislature · 2026-09-01 · Source review 2026-10-15
- AB280 official bill historyOfficial · California Legislature · Source review 2026-10-15
Complete edition and supplemental material
This finding in the complete approved report →Regulatory horizons, CIA trends and implementation trackers remain in the full report.
Read the entire Medicare & Medicaid report →