BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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                                 THIRD READING


          Bill No:  AB 2275
          Author:   Hayashi (D), et al
          Amended:  8/17/10 in Senate
          Vote:     21

           
           SENATE HEALTH COMMITTEE  :  8-0, 6/30/10
          AYES: Alquist, Strickland, Aanestad, Cedillo, Leno, Negrete  
            McLeod, Pavley, Romero
          NO VOTE RECORDED: Cox

           SENATE APPROPRIATIONS COMMITTEE  :  9-0, 8/12/10
          AYES: Kehoe, Ashburn, Alquist, Corbett, Emmerson, Leno,  
            Wolk, Wyland, Yee
          NO VOTE RECORDED: Price, Walters

           ASSEMBLY FLOOR  :  71-0, 5/10/10 - See last page for vote


           SUBJECT  :    Dental coverage: noncovered benefits

           SOURCE  :     Author


           DIGEST  :    This bill prohibits 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.  

                                                           CONTINUED





                                                               AB 2275
                                                                Page  
          2

           ANALYSIS :    Under existing law, the Department of Managed  
          Health Care and the Department of Insurance are responsible  
          for the licensure and regulation of health care service  
          plans and insurers, respectively.  Existing law requires  
          contracts between plans or insurers and providers to be  
          fair and reasonable and the Office of Patient Advocate  
          within the Department of Managed Health Care to represent  
          the interests of enrollees served by health care service  
          plans regulated by the department.

          This bill prohibits 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 also prohibits 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 applies  
          to provider contracts that are issued, revised, or renewed  
          on or after January 1, 2011.

          This bill requires 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 call their plan or insurer's  
          member services or insurance broker, if they wanted more  
          information about their dental coverage options. 

          This bill provides that prior to providing a patient with  
          dental services that are not a covered benefit, the dentist  
          should provide to the patient a treatment plan that  
          includes each anticipated service to be provided and the  
          estimated cost of each service.

          This bill encourages individuals to carefully review their  
          coverage documents for details about their covered and  
          non-covered benefits.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    







                                                              AB 2275
                                                                Page  
          3

          Local:  Yes

          According to the Senate Appropriations Committee: 

                          Fiscal Impact (in thousands)

           Major Provisions                2010-11     2011-12     
           2012-13  Fund  
          CDI review dental policies                              
          minor and absorbable                              Special*
          and help-line calls

          DMHC oversight and                                $60 - $70  
          ongoing unknown, but likely                       Special**
          help center calls        minor and absorbable

          *Insurance Fund
          **Managed Care Fund


           ASSEMBLY FLOOR  :  
          AYES: Adams, Ammiano, Anderson, Arambula, Bass, Beall, Bill  
            Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,  
            Bradford, Brownley, Buchanan, Caballero, Charles  
            Calderon, Carter, Chesbro, Conway, Cook, Coto, Davis, De  
            Leon, Emmerson, Eng, Evans, Feuer, Fletcher, Fong,  
            Fuentes, Fuller, Furutani, Gaines, Galgiani, Garrick,  
            Gilmore, Hagman, Hall, Hayashi, Hernandez, Hill, Huber,  
            Huffman, Jeffries, Jones, Knight, Lieu, Logue, Bonnie  
            Lowenthal, Ma, Miller, Monning, Nestande, Niello,  
            Nielsen, V. Manuel Perez, Portantino, Ruskin, Salas,  
            Silva, Skinner, Smyth, Audra Strickland, Swanson,  
            Torlakson, Torres, Torrico, Tran, Villines, Yamada, John  
            A. Perez
          NO VOTE RECORDED: De La Torre, DeVore, Harkey, Mendoza,  
            Nava, Norby, Saldana, Solorio, Vacancy


          AGB:nl  8/17/10   Senate Floor Analyses 

                       SUPPORT/OPPOSITION:  NONE RECEIVED

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