AB 1629: Dental coverage.

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 acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law prohibits a contract between a plan or insurer and a dentist from requiring a dentist to accept an amount set by the plan or insurer as payment for dental care services provided to an enrollee or insured that are not covered services under the enrollees contract or the insureds policy. Existing law requires a plan or insurer to make specified disclosures to an enrollee or insured regarding noncovered dental services.

Existing law requires a health care service plan or health insurer to comply with specified timely access requirements. Under existing law, a health care service plan is required to annually report to the Department of Managed Health Care on this compliance. Existing law authorizes the Department of Insurance to issue guidance to insurers regarding annual timely access and network reporting methodologies.

This bill would require a plan or insurer, including a specialized plan or insurer, covering dental services, to pay a noncontracting dental provider, which includes a registered dental hygienist in alternative practice, directly for covered services rendered to the enrollee or insured in accordance with the benefit provided in the contract or policy when the noncontracting dental provider submits to the plan or insurer an assignment of benefits. The bill would require a noncontracting dental provider to obtain a signed and dated consent to collect an assignment of benefits from an enrollee or insured. The bill would prohibit a noncontracting dental provider collecting an enrollees or insureds assignment of benefits from charging an enrollee or insured, prior to the plan or insurer payment, more than an estimate of the enrollees or the insureds cost sharing for the treatment or a deposit that approximates that cost share. Because a willful violation of these provisions relative to health care service plans would be a crime, this bill would impose a state-mandated local program.

This bill would require a plan or insurer to certify, under penalty of perjury, that specified information submitted to its regulator regarding network adequacy is true and correct, thus creating a crime and imposing a state-mandated local program.

Existing law, the Dental Practice Act, provides for the licensure and regulation of dentists and dental assistants by the Dental Board of California and the licensure and regulation of dental hygienists by the Dental Hygiene Board of California, and defines unprofessional conduct by a licensee, including, among other things, the violation of any provision of the act. Existing law authorizes the respective board to discipline a licensee under the act by placing the licensee on probation under various specified terms and conditions.

This bill would require a noncontracting dental provider, including a registered dental hygienist in alternative practice, to make specified disclosures to a patient before collecting the patients signed and dated consent to an assignment of benefits. The bill would expand the definition of unprofessional conduct under the act to include the failure to comply with that disclosure requirement and the above-described prohibition relating to the charging of a patient more than an estimate of their cost sharing and the failure to maintain a signed and dated copy of the patients consent.

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.