BILL ANALYSIS ------------------------------------------------------------ |SENATE RULES COMMITTEE | AB 2275| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ 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 **** END ****