BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
2275 (Hayashi)
Hearing Date: 8/9/2010 Amended: 7/15/2010 and as
proposed
Consultant: Katie Johnson Policy Vote: Health 8-0
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BILL SUMMARY: AB 2275 would prohibit a contract between a
health care service plan, a specialized health care service
plan, or an insurer and a dentist from requiring a dentist to
accept a payment amount set by the plan for dental care services
provided to an enrollee, but that are not covered services under
the contract, commencing with provider contracts issued,
revised, or renewed on or after January 1, 2011.
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Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
CDI review dental policies $200 $360
$360Special*
and help-line calls
DMHC oversight and $60 - $70 at least $150 at least
$150 Special**
help center calls
*Insurance Fund
**Managed Care Fund
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STAFF COMMENTS: This bill meets the criteria for referral to the
Suspense File.
This bill would prohibit a contract between a health care
service plan, a specialized health care service plan, or an
insurer and a dentist from requiring a dentist to accept a
payment amount set by the plan for dental care services provided
to an enrollee, but that are not covered services under the
contract. This bill would also prohibit a provider from charging
more for dental services that are not covered services under the
contract or policy than his or her usual and customary rate for
those services. This bill would apply to provider contracts that
are issued, revised, or renewed on or after January 1, 2011.
Staff notes that the pending author's amendments agreed to in
the Senate Health Committee and that will be taken in this
committee and on which this analysis is based would require that
health plan contracts and health insurance policies that are
issued, amended, or renewed on or after July 1, 2011, include in
their evidence of coverage and disclosure forms a notice that
would inform enrollees and policyholders that a dentist may
charge him or her his or her usual and customary rate for
services not covered by the contract or policy and would direct
enrollees and policyholders to contact their plan or insurer's
member services, insurance broker, or CDI or the Office of the
Patient Advocate (OPA) within DMHC if they wanted more
information about their dental coverage options.
The California Department of Insurance (CDI) would need up to
$200,000 in FY 2010-2011 and up to $360,000 ongoing in staffing
resources in order to comply with this bill,
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AB 2275 (Hayashi)
including to review filings and to answer consumer calls to its
800 number. Costs to the Department of Managed Health Care
(DMHC) to perform similar duties would be about $60,000 to
$70,000 in FY 2010-2011, and at least $150,000 in FY 2011-2012.
For example, DMHC regulates Delta Dental, one of the largest
dental plans in California with over 17 million members. If 0.1
percent of those members called the DMHC helpline for assistance
for 15 minutes each, the department would need approximately 2.5
PYs to cover the workload.