Bill Text: CA SB1369 | 2023-2024 | Regular Session | Amended
Bill Title: Dental providers: fee-based payments.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed) 2024-06-13 - Read second time and amended. Re-referred to Com. on APPR. [SB1369 Detail]
Download: California-2023-SB1369-Amended.html
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Amended
IN
Assembly
June 13, 2024 |
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Amended
IN
Senate
April 29, 2024 |
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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 April
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 health care service plan, health insurer, or contracted vendor to obtain a signed authorization or an electronic signature written 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 or electronic notice written authorization to
the health care service plan, health insurer, or contracted vendor. The bill would require a health care service plan, health insurer, or contracted vendor that obtains written authorization to opt in or opt out of fee-based payment to apply the decision to include both the dental provider’s entire practice and all products or services covered pursuant to a contract with the dental provider, as specified.
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.
(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.
(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.
(4) “Health care service plan” or “plan” means a health care service plan defined in paragraph (2) of subdivision (a) of Section 1374.194.
(5) “Written authorization” means a dental provider’s express consent to opt in or opt out of receiving fee-based payment indicated by a provider’s written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment.
(b) (1) A health care service plan contract issued, amended, or renewed
on and after January April 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.
(2) The health care service plan shall remit or associate with each payment the claims and claim details associated with payment.
(c) (1) A health care service plan or its contracted vendor shall obtain a signed authorization or an electronic signature
written 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.
(2) At the time a dental provider opts in to 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 charged by the plan or contracted vendor, alternative methods of payment, instructions on how to opt out of the fee-based payment method, and a notice of the dental provider’s ability to opt out of the fee-based payment method at any time.
(3) Upon receipt of the dental provider’s signed authorization or electronic signature,
written authorization, the health care service plan or its contracted vendor subsequently may issue payments to the dental provider using a fee-based payment method.
(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 or electronic notice authorization 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),
the provider’s payment method decision shall remain in effect until the provider informs the plan or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.
(e) A health care service plan or its contracted vendor that obtains a dental provider’s written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:
(1) The dental provider’s entire practice.
(2) To
all products or services covered by the health care service plan pursuant to a contract with the dental provider, including network provider contracts, as described in Section 1374.193.
(e)
(f) 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.
(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.
(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.
(4) “Health insurer” has the same meaning as defined in paragraph (2) of subdivision (a) of Section 10120.41.
(5) “Written authorization” means a dental provider’s express consent to opt in or opt out of receiving fee-based payment indicated by a provider’s written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment.
(b) (1) A health insurance policy issued, amended, or
renewed on and after January
April 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.
(2) A health insurer shall remit or associate with each payment the claims and claim details associated with payment.
(c) (1) A health insurer or its contracted vendor shall obtain a signed authorization or an electronic signature written 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.
(2) At the time a dental provider opts in to 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
charged by the health insurer or contracted vendor,
alternative methods of payment, instructions on how to opt-out of the fee-based payment method, and a notice of the dental provider’s ability to opt out of a fee-based payment method at any time.
(3) Upon receipt of the signed authorization or electronic signature, written authorization, the health insurer or its contracted vendor subsequently may issue payments using a fee-based payment method.
(4) A health insurer also shall notify the dental provider if its contracted vendor is sharing a 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 or electronic notice authorization to the health insurer or its contracted vendor.
(2) If a dental provider opts out of a method of
payment pursuant to paragraph (1), the provider’s payment method decision shall remain in effect until the provider informs the health insurer or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.
(e) A health insurer or its contracted vendor that obtains a dental provider’s written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:
(1) The dental provider’s entire practice.
(2) To all products or services covered by the health insurer pursuant to a contract with the dental provider, including network provider contracts, as described in Section 10120.4.
