This bill mandates that health insurance carriers in the state implement network access compliance protocols that align with the "secret shopper" audit requirements set by the Centers for Medicare and Medicaid Services (CMS) for Qualified Health Plan issuers. Specifically, starting January 1, 2027, carriers must conduct annual secret shopper surveys to assess compliance with appointment wait time standards and provider accessibility requirements. The bill requires carriers to contract with an independent third-party entity to perform these surveys, which must include behavioral health and primary care providers, and potentially specialty care providers as directed by CMS. The results of these surveys must be submitted to the insurance department by May 31 each year.

Additionally, the bill introduces provisions for penalties against carriers that fail to comply with the audit requirements, including civil monetary penalties and reimbursement of out-of-network claims incurred by enrollees. The insurance department is tasked with adopting rules to implement these requirements, including procedures for reporting and public transparency of survey results. The bill also specifies that noncompliant carriers must enter into a corrective action plan with the insurance department. Overall, the bill aims to enhance the monitoring of health carrier network access and ensure compliance with established standards.