Bill Text: CA SB1369 | 2023-2024 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Dental providers: fee-based payments.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Enrolled) 2024-09-04 - Enrolled and presented to the Governor at 4 p.m. [SB1369 Detail]
Download: California-2023-SB1369-Amended.html
Bill Title: Dental providers: fee-based payments.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Enrolled) 2024-09-04 - Enrolled and presented to the Governor at 4 p.m. [SB1369 Detail]
Download: California-2023-SB1369-Amended.html
|
Amended
IN
Senate
April 09, 2024 |
CALIFORNIA LEGISLATURE—
2023–2024 REGULAR SESSION
Senate Bill
No. 1369
| Introduced by Senator Limón |
February 16, 2024 |
An act to add Section 1371.11 to the Health and Safety Code, and to add Section 10123.146 to the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 1369, as amended, Limón.
Dental providers: fee-based payments.
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’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes specified coverage and disclosure requirements on health care service plans and health insurers, including specialized plans and insurers, that cover dental services.
This bill would require a health care service plan contract or health insurance policy, as defined, issued, amended, or renewed on and after January 1, 2025, that provides payment directly or through a contracted vendor to a dental provider to have a non-fee-based default method of payment, as specified. The bill would require a dental provider to submit a signed authorization to the
health care service plan, health insurer, or contracted vendor, opting in to a fee-based payment method, vendor to obtain a signed authorization from a dental provider opting in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider and would authorize the dental provider to opt out of the fee-based payment method at any time by providing written notice to the health care service plan, health insurer, or contracted vendor.
Because a violation of the bill’s requirements by a health care service plan 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.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1371.11 is added to the Health and Safety Code, to read:1371.11.
(a) The following definitions apply for purposes of this section:(1) “Contracted vendor” means a third party facilitating payment processing on behalf of the health care service plan.
(1)
(2) “Dental provider” means an individual or group of individuals licensed under Chapter 4
(commencing with Section 1600) of Division 2 of the Business and Professions Code.
(2)
(3) “Fee-based payment” refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor.
(3)
(4) “Health care service plan” or “plan” means
a health care service plan defined in paragraph (2) of subdivision (a) of Section 1374.194.
(b) (1) A health care service plan contract issued, amended, or renewed on and after January 1, 2025, that provides payment directly, or through a contracted vendor, to a dental provider, shall have a non-fee-based default method of payment, including, but not limited to, electronic funds transfer or mailed check.
(2) The health care service plan shall remit or associate with each payment the claims and claim details associated with payment.
(c)A dental provider is not required to use a fee-based payment method unless the dental provider submits to the health care service plan or contract vendor a signed
authorization opting in to the fee-based payment system.
(c) (1) A health care service plan or its contracted vendor shall obtain a signed authorization from a dental provider opting in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider.
(1)
(2) If a dental provider opts in to the
a
fee-based payment method, the health care service plan or its contracted vendor shall provide information on the payment method, including a notice of the fees associated, alternative methods of payment, and instructions on how to opt out of the fee-based payment method.
(2)
(3) Upon receipt of the dental provider’s signed authorization, the health insurer care service plan or its contracted vendor subsequently
may issue payments to the dental provider using the
a fee-based payment method.
(3)
(4) The health care service plan also shall notify the dental provider if its contracted vendor is sharing any part of the profit, fee arrangement, or board composition with the plan.
(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written notice to the health care service plan or its contracted vendor.
(2) If a dental provider opts out of a fee-based method of payment pursuant to paragraph (1), that decision remains in effect until the provider opts back in to the prior method of payment.
(e) This section does not change, alter, or extend the scope of Section 1367.
SEC. 2.
Section 10123.146 is added to the Insurance Code, to read:10123.146.
(a) The following definitions shall apply for purposes of this section:(1) “Contracted vendor” means a third party facilitating payment processing on behalf of the health insurer.
(1)
(2) “Dental provider” means an individual or group of individuals licensed under Chapter 4
(commencing with Section 1600) of Division 2 of the Business and Professions Code.
(2)
(3) “Fee-based payment” refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor.
(3)
(4) “Health insurer” has the same meaning as
defined in paragraph (2) of subdivision (a) of Section 10120.41.
(b) (1) A health insurance policy issued, amended, or renewed on and after January 1, 2025, that provides payment directly, or through a contracted vendor to a dental provider, shall have a non-fee-based default method of payment, including, but not limited to, electronic funds transfer or mailed check.
(2) A health insurer shall remit or associate with each payment the claims and claim details associated with payment.
(c)A dental provider is not required to use a fee-based payment method unless the dental provider submits to the health insurer or contracted vendor a signed authorization opting in to the fee-based payment
system.
(c) (1) A health insurer or its contracted vendor shall obtain a signed authorization from a dental provider opting in to a fee-based payment method before the insurer or vendor provides a fee-based payment method to the provider.
(1)
(2) If a dental provider opts in to the a
fee-based payment method, the health insurer or its contracted vendor shall provide information on the payment method, including a notice of the fees associated,
alternative methods of payment, and instructions on how to opt-out of the fee-based payment model. method.
(2)
(3) Upon receipt of the signed authorization, the health insurer or its contracted vendor subsequently may issue payments using the a
fee-based payment method.
(3)
(4) A health insurer also shall notify the dental provider if its contracted vendor is sharing a part of the profit, fee arrangement arrangement, or board composition with the plan.
(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by
providing written notice to the health insurer or its contracted vendor.
(2) If a dental provider opts out of a method of payment, that decision remains in effect until the provider opts back in to the prior method of payment.
