1374.1965.
(a) Commencing January 1, 2027, or when final rules are implemented by the federal government, the final federal rules for impacted payers are implemented, whichever is later, a specialized health care service plan, not subject to Section 1374.196, that issues, sells, renews, or offers a contract covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:(1) Patient access
API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.
(2) Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.
(3) Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.
(b) In addition to the API described in subdivision (a), the department may require a dental or vision plan to establish and maintain the following API if and when final rules are published by the federal government:
(1) Provider access API.
(2) Prior authorization support API.
(c) API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.
(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.
(e)This section does not apply to a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services with 90,000 or fewer enrollees who are California residents across all dental or vision product lines.