SB 242: Health care provider reimbursements.
- Session Year: 2021-2022
- House: Senate
- Latest Version Date: 2021-10-05
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 a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law authorizes a health care service plan or health insurer to contract with a provider for alternative rates of payment.
This bill would require a health care service plan or health insurer, but not a Medi-Cal managed care plan, to reimburse contracting health care providers for their business expenses to prevent the spread of respiratory-transmitted infectious diseases causing public health emergencies declared on or after January 1, 2022. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the 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.
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 a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law authorizes a health care service plan or health insurer to contract with a provider for alternative rates of payment.
This bill would require a health care service plan or health insurer, but not a Medi-Cal managed care plan, to reimburse contracting health care providers for their business expenses to prevent the spread of respiratory-transmitted infectious diseases causing public health emergencies declared on or after January 1, 2022. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the 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.
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 a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law authorizes a health care service plan or health insurer to contract with a provider for alternative rates of payment.
This bill would require a health care service plan or health insurer insurer, but not a Medi-Cal managed care plan, to reimburse contracting health care providers for their business expenses to prevent the spread of respiratory-transmitted infectious diseases causing public health emergencies declared on or after January 1, 2022. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the 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.
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 a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law authorizes a health care service plan or health insurer to contract with a provider for alternative rates of payment.
This bill would require a health care service plan or health insurer to contract with its health care providers to reimburse, at a reasonable rate, reimburse contracting health care providers for their business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of respiratory-transmitted infectious diseases causing public health emergencies. emergencies declared on or after January 1, 2022. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the 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.
This bill would declare that it is to take effect immediately as an urgency statute.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 a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law authorizes a health care service plan or health insurer to contract with a provider for alternative rates of payment.
Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires the director of the department to establish and periodically review and revise the statewide Medi-Cal reimbursement rates for health care services. Under existing law, Medi-Cal reimbursement rates do not distinguish between services provided by a physician and services provided by a dentist.This bill would require a health care service plan or health insurer to contract with its health care providers to reimburse, at a reasonable rate, their business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies. The bill would require the State Department of Health Care Services to similarly reimburse a Medi-Cal provider after undertaking a process to set a reasonable rate in consultation with provider groups. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the 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.
This bill would declare that it is to take effect immediately as an urgency statute.
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 a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law authorizes a health care service plan or health insurer to contract with a provider for alternative rates of payment.
Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires the director of the department to establish and periodically review and revise the statewide Medi-Cal reimbursement rates for health care services. Under existing law, Medi-Cal reimbursement rates do not distinguish between services provided by a physician and services provided by a dentist.
This bill would require a health care service plan or health insurer to contract with its health care providers to reimburse, at a reasonable rate, their business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies. The bill would require the State Department of Health Care Services to similarly reimburse a Medi-Cal provider after undertaking a process to set a reasonable rate in consultation with provider groups. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the 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.
This bill would declare that it is to take effect immediately as an urgency statute.
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 a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law authorizes a health care service plan or health insurer to contract with a provider for alternative rates of payment.
Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires the director of the department to establish and periodically review and revise the statewide Medi-Cal reimbursement rates for health care services. Under existing law, Medi-Cal reimbursement rates do not distinguish between services provided by a physician and services provided by a dentist.
This bill would require a health care service plan or health insurer to contract with its health care providers to reimburse, at a reasonable rate, their business expenses that are medically necessary to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies. The bill would require the State Department of Health Care Services to similarly reimburse a Medi-Cal provider after undertaking a process to set a reasonable rate in consultation with provider groups. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the 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.
This bill would declare that it is to take effect immediately as an urgency statute.
(a)Notwithstanding any other law, a health care service plan, including a specialized health care service plan and a health care service plan that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses to prevent the spread of diseases causing public health emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).
(b)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per enrollee for the duration of the public health emergency.
(c)A change to a contract between a health care service plan and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health care service plan shall not delegate the financial risk to a contracted health care provider for the cost of enrollee services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 1375.7.
(d)The department shall ensure a health care service plan provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(e)For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the enrollees health care service plan. The term contracting health care provider only applies to a dentist if the enrollee is covered by a health care service plan contract or specialized health care service plan contract that includes dental benefits.
(f)This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
(g)This section shall not apply to a Medi-Cal managed care plan that contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code.
SEC. 2.Section 10120.35 is added to the Insurance Code, to read:10120.35.(a)Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses to prevent the spread of diseases causing public health emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).
(b)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per insured for the duration of the public health emergency.
(c)The department shall ensure a health insurer provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(d)For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the insureds health insurer. The term contracting health care provider only applies to a dentist if the insured is covered by a health insurance policy or specialized health insurance policy that includes dental benefits.
(e)This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
(f)This section shall not apply to a Medi-Cal managed care plan that contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code.
SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)Notwithstanding any other law, a health care service plan, including a specialized health care service plan and a health care service plan that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses to prevent the spread of diseases causing public health emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).
(b)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per enrollee for the duration of the public health emergency.
(c)A change to a contract between a health care service plan and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health care service plan shall not delegate the financial risk to a contracted health care provider for the cost of enrollee services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 1375.7.
(d)The department shall ensure a health care service plan provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(e)For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the enrollees health care service plan. The term contracting health care provider only applies to a dentist if the enrollee is covered by a health care service plan contract or specialized health care service plan contract that includes dental benefits.
(f)This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
(g)This section shall not apply to a Medi-Cal managed care plan that contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code.
SEC. 2.Section 10120.35 is added to the Insurance Code, to read:10120.35.(a)Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses to prevent the spread of diseases causing public health emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).
(b)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per insured for the duration of the public health emergency.
(c)The department shall ensure a health insurer provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(d)For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the insureds health insurer. The term contracting health care provider only applies to a dentist if the insured is covered by a health insurance policy or specialized health insurance policy that includes dental benefits.
(e)This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
(f)This section shall not apply to a Medi-Cal managed care plan that contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code.
SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)Notwithstanding any other law, a health care service plan, including a specialized health care service plan and a health care service plan that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses to prevent the spread of diseases causing public health emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).
(b)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per enrollee for the duration of the public health emergency.
(c)A change to a contract between a health care service plan and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health care service plan shall not delegate the financial risk to a contracted health care provider for the cost of enrollee services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 1375.7.
(d)The department shall ensure a health care service plan provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(e)For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the enrollees health care service plan. The term contracting health care provider only applies to a dentist if the enrollee is covered by a health care service plan contract or specialized health care service plan contract that includes dental benefits.
(f)This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
(g)This section shall not apply to a Medi-Cal managed care plan that contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code.
SEC. 2.Section 10120.35 is added to the Insurance Code, to read:10120.35.(a)Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses to prevent the spread of diseases causing public health emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).
(b)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per insured for the duration of the public health emergency.
(c)The department shall ensure a health insurer provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(d)For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the insureds health insurer. The term contracting health care provider only applies to a dentist if the insured is covered by a health insurance policy or specialized health insurance policy that includes dental benefits.
(e)This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
(f)This section shall not apply to a Medi-Cal managed care plan that contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code.
SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)Notwithstanding any other law, a health care service plan, including a specialized health care service plan and a health care service plan that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).
(b)(1)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the plan and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.(2)A health care service plan may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(b)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per enrollee for the duration of the public health emergency.
(c)A change to a contract between a health care service plan and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health care service plan shall not delegate the financial risk to a contracted health care provider for the cost of enrollee services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 1375.7.
(d)The department shall ensure a health care service plan provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(e)For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the enrollees health care service plan. The term contracting health care provider only applies to a dentist if the enrollee is covered by a health care service plan contract or specialized health care service plan contract that includes dental benefits.
(f)This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
SEC. 2.Section 10120.35 is added to the Insurance Code, to read:10120.35.(a)Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).
(b)(1)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the insurer and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.(2)A health insurer may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(c)A change to a contract between a health insurer and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health insurer shall not delegate the financial risk to a contracted health care provider for the cost of insured services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 10133.65.(b)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per insured for the duration of the public health emergency.
(d)(c)The department shall ensure a health insurer provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(e)(d)For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the insureds health insurer. The term contracting health care provider only applies to a dentist if the insured is covered by a health insurance policy or specialized health insurance policy that includes dental benefits.
(e)This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:To protect the health of frontline medical and dental personnel, which ensures the ongoing availability of medical and dental practices, thus safeguarding access to care, and due to the paradigm shift increasing the level of expectation of infection control protocols during, and likely following, the COVID-19 pandemic, it is necessary for this act to take effect immediately.(a)Notwithstanding any other law, a health care service plan, including a specialized health care service plan and a health care service plan that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing.
(b)(1)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the plan and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.
(2)A health care service plan may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.
(c)A change to a contract between a health care service plan and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health care service plan shall not delegate the financial risk to a contracted health care provider for the cost of enrollee services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 1375.7.
(d)The department shall ensure a health care service plan provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations to implement this section.
(e)For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the enrollees health care service plan.
SEC. 2.Section 10120.35 is added to the Insurance Code, to read:10120.35.(a)Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing.
(b)(1)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the insurer and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.
(2)A health insurer may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.
(c)A change to a contract between a health insurer and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health insurer shall not delegate the financial risk to a contracted health care provider for the cost of insured services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 10133.65.
(d)The department shall ensure a health insurer provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations to implement this section.
(e)For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the insureds health insurer.
SEC. 3.Section 14079.8 is added to the Welfare and Institutions Code, to read:14079.8.(a)Notwithstanding any other law, the department shall reimburse physicians and dentists for business expenses that are medically necessary to render treatment to patients, to protect health care workers, and to comply with a public health order to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical or diagnostic equipment including testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing, or other related information technology expenses.(b)(1)The department shall undertake a process to set reimbursement pursuant to subdivision (a) at a reasonable rate after consultation with provider groups. The reimbursement rate paid to dentists shall be the same as the rate paid to physicians, pursuant to Section 14079.5.(2)The department may provide supplemental payments to a physician or dentist to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(c)The department shall ensure that reimbursement pursuant to subdivision (a) is provided timely to physicians and dentists. The department may adopt regulations to implement this section.SEC. 4.SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 5.SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
To protect the health of frontline medical and dental personnel, which ensures the ongoing availability of medical and dental practices, thus safeguarding access to care, and due to the paradigm shift increasing the level of expectation of infection control protocols during, and likely following, the COVID-19 pandemic, it is necessary for this act to take effect immediately.
(a)Notwithstanding any other law, a health care service plan, including a specialized health care service plan and a health care service plan that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical or diagnostic equipment including testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing, or other related information technology expenses. testing.
(b)(1)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the plan and provider. provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.
(2)A health care service plan may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.
(c)A change to a contract between a health care service plan and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health care service plan shall not delegate the financial risk to a contracted health care provider for the cost of enrollee services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 1375.7.
(d)The department shall ensure a health care service plan provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations to implement this section.
(e)For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the enrollees health care service plan.
SEC. 2.Section 10120.35 is added to the Insurance Code, to read:10120.35.(a)Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical or diagnostic equipment including testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing, or other related information technology expenses. testing.
(b)(1)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the insurer and provider. provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.
(2)A health insurer may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.
(c)A change to a contract between a health insurer and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health insurer shall not delegate the financial risk to a contracted health care provider for the cost of insured services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 10133.65.
(d)The department shall ensure a health insurer provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations to implement this section.
(e)For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the insureds health insurer.
SEC. 3.Section 14079.8 is added to the Welfare and Institutions Code, to read:14079.8.(a)Notwithstanding any other law, the department shall reimburse physicians and dentists for business expenses that are medically necessary to render treatment to patients, to protect health care workers, and to comply with a public health order to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical or diagnostic equipment including testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing, or other related information technology expenses.
(b)(1)The department shall undertake a process to set reimbursement pursuant to subdivision (a) at a reasonable rate after consultation with provider groups. The reimbursement rate paid to dentists shall be the same as the rate paid to physicians, pursuant to Section 14079.5.
(2)The department may provide supplemental payments to a physician or dentist to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.
(c)The department shall ensure that reimbursement pursuant to subdivision (a) is provided timely to physicians and dentists. The department may adopt regulations to implement this section.
SEC. 4.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 5.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
To protect the health of frontline medical and dental personnel, which ensures the ongoing availability of medical and dental practices, thus safeguarding access to care, and due to the paradigm shift increasing the level of expectation of infection control protocols during, and likely following, the COVID-19 pandemic, it is necessary for this act to take effect immediately.
(a)Notwithstanding any other law, a health care service plan, including a specialized health care service plan and a health care service plan that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical or diagnostic equipment including testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing, or other related information technology expenses.
(b)(1)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the plan and provider. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.
(2)A health care service plan may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.
(c)A change to a contract between a health care service plan and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health care service plan shall not delegate the financial risk to a contracted health care provider for the cost of enrollee services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 1375.7.
(d)The department shall ensure a health care service plan provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations to implement this section.
SEC. 2.Section 10120.35 is added to the Insurance Code, to read:10120.35.(a)Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical or diagnostic equipment including testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing, or other related information technology expenses.
(b)(1)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the insurer and provider. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.
(2)A health insurer may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.
(c)A change to a contract between a health insurer and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health insurer shall not delegate the financial risk to a contracted health care provider for the cost of insured services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 10133.65.
(d)The department shall ensure a health insurer provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations to implement this section.
SEC. 3.Section 14079.8 is added to the Welfare and Institutions Code, to read:14079.8.(a)Notwithstanding any other law, the department shall reimburse physicians and dentists for business expenses that are medically necessary to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical or diagnostic equipment including testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing, or other related information technology expenses.
(b)(1)The department shall undertake a process to set reimbursement pursuant to subdivision (a) at a reasonable rate after consultation with provider groups. The reimbursement rate paid to dentists shall be the same as the rate paid to physicians, pursuant to Section 14079.5.
(2)The department may provide supplemental payments to a physician or dentist to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.
(c)The department shall ensure that reimbursement pursuant to subdivision (a) is provided timely to physicians and dentists. The department may adopt regulations to implement this section.
SEC. 4.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 5.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
To protect the health of frontline medical and dental personnel, which ensures the ongoing availability of medical and dental practices, thus safeguarding access to care, and due to the paradigm shift increasing the level of expectation of infection control protocols during, and likely following, the COVID-19 pandemic, it is necessary for this act to take effect immediately.
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Date
|
Status
|
|---|---|
| Oct 5, 2021 | Chaptered by Secretary of State. Chapter 538, Statutes of 2021. |
| Oct 5, 2021 | Approved by the Governor. |
| Sep 17, 2021 | Enrolled and presented to the Governor at 1:30 p.m. |
| Sep 9, 2021 | Assembly amendments concurred in. (Ayes 29. Noes 9. Page 2554.) Ordered to engrossing and enrolling. |
| Sep 8, 2021 | In Senate. Concurrence in Assembly amendments pending. |
| Sep 8, 2021 | Read third time. Passed. (Ayes 58. Noes 11. Page 2912.) Ordered to the Senate. |
| Aug 31, 2021 | Read second time. Ordered to third reading. |
| Aug 30, 2021 | Read second time and amended. Ordered to second reading. |
| Aug 26, 2021 | August 26 set for first hearing. Placed on APPR. suspense file. |
| Aug 16, 2021 | Read second time and amended. Re-referred to Com. on APPR. |
| Jul 19, 2021 | From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 1.) (July 13). |
| Jun 10, 2021 | Referred to Com. on HEALTH. |
| Jun 2, 2021 | In Assembly. Read first time. Held at Desk. |
| Jun 1, 2021 | Read third time. Urgency clause adopted. Passed. (Ayes 30. Noes 8. Page 1329.) Ordered to the Assembly. |
| May 20, 2021 | From committee: Do pass. (Ayes 5. Noes 2. Page 1184.) (May 20). |
| May 14, 2021 | Set for hearing May 20. |
| Apr 20, 2021 | April 19 hearing: Placed on APPR suspense file. |
| Apr 13, 2021 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on APPR. |
| Apr 9, 2021 | Set for hearing April 19. |
| Mar 15, 2021 | Read second time and amended. Re-referred to Com. on APPR. |
| Mar 11, 2021 | From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 8. Noes 2. Page 456.) (March 10). |
| Feb 17, 2021 | Set for hearing March 10. |
| Feb 3, 2021 | Referred to Com. on HEALTH. |
| Jan 22, 2021 | From printer. May be acted upon on or after February 21. |
| Jan 21, 2021 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
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Date
|
Description
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Location
|
Votes
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|
|---|---|---|---|---|
| Sep 9, 2021 | Unfinished Business SB242 Newman et al. Concurrence | Senate Floor |
Passed |
|
| Sep 8, 2021 | SB 242 Newman Senate Third Reading By Robert Rivas | Assembly Floor |
Passed |
|
| Jun 1, 2021 | Senate 3rd Reading SB242 Newman et al. Urgency Clause | Senate Floor |
Passed |
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Positions by individuals are not included.
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