BILL ANALYSIS Ó
AB 2252
Page 1
ASSEMBLY THIRD READING
AB 2252 (Gordon)
As Amended May 25, 2012
Majority vote
HEALTH 18-0 APPROPRIATIONS 16-0
-----------------------------------------------------------------
|Ayes:|Monning, Logue, Ammiano, |Ayes:|Fuentes, Harkey, |
| |Atkins, Bonilla, Eng, | |Blumenfield, Bradford, |
| |Garrick, Gordon, Hayashi, | |Charles Calderon, Campos, |
| |Roger Hernández, | |Davis, Gatto, Ammiano, |
| |Bonnie Lowenthal, | |Hill, Lara, Mitchell, |
| |Mansoor, Mitchell, | |Nielsen, Norby, Solorio, |
| |Nestande, Pan, | |Wagner |
| |V. Manuel Pérez, Silva, | | |
| |Williams | | |
| | | | |
-----------------------------------------------------------------
SUMMARY : Requires, if a material change is made to the rules,
regulations, guidelines, policies, or procedures governing
contracting, coverage, or payment for dental services to a
health care service plan (health plan) contract, specialized
health plan contract covering dental, a health insurance policy
or specialized health insurance policy covering dental services,
the plan or insurer to provide notice of at least 45 business
days and give the dentist an opportunity to negotiate or
terminate the contract. Specifically, this bill :
1)Includes as written notice, notice by electronic mail or
facsimile transmission.
2)Provides that a material change includes but is not limited
to: a change to the system by which the plan adjudicates and
pays claims for treatment that may cause delays disruptions to
processing claims or making eligibility determinations; and, a
change to the general coverage or general policies of the plan
that affect rates and fees paid to providers.
3)Requires a plan or insurer that automatically renews a
contract with a dental provider to, at least 45 business days
prior to the contract renewal date, provide to the provider a
summary of the changes described in this bill that have been
made since the contract was issued or last renewed, whichever
AB 2252
Page 2
is later.
4)Exempts from this bill a health plan that exclusively
contracts with no more than two medical groups in the state to
provide or arrange for the provision of professional medical
services to the enrollees of the plan.
5)Gives the provider the right to terminate the contract within
30 business days of receiving the summary. Requires if the
provider does not notify the plan or insurer of its desire to
terminate the contract within that 30-business-day period, the
contract to be automatically renewed.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, this bill will have minor one-time costs, in the
range of $50,000, to the Department of Managed Health Care and
the California Department of Insurance, combined, to ensure
plans are compliant with this bill's requirements during the
licensure review process.
COMMENTS : According to the author, dentists often practice in
solo practitioner or small group settings, where changes to
plans can impact practice staffing, cost of care, and patient
access to services. If a dentist does not have current
information on preauthorization timing, reimbursement rates, or
claims processing, then he or she is unable to convey to the
patient what is expected of them so that they can make a fully
informed decision. The author describes a situation where a
recent dental plan operating in California installed a new
system for claims review and payment, provider identification,
and patient eligibility confirmation in which, system problems
have affected aspects of how claims for treatment are paid,
impacting patients on what gets paid and how much is the
patient's responsibility. Moreover, system errors have arisen
leading to delays in preauthorization approvals for necessary
treatment plans and inaccuracies have resulted in plans seeking
refunds from dentists and patients for incorrectly paid claims.
This bill is sponsored by the California Dental Association
(CDA) to strengthen the partnership that already exists between
providers and plans by ensuring that adequate notification of
significant changes in plan polices are communicated in a
transparent and timely manner. CDA provides an example of a
plan which previously updated its individual provider fees on an
annual basis but in 2011 froze fees and did not inform dentists
AB 2252
Page 3
of this change for six months.
Delta Dental of California believes this bill is overly broad.
Provider participation requirements, claims processing policies,
credentialing policies, and language assistance capabilities may
relate to provider contracts, or may relate to coverage but are
not typically part of the contract. The California Association
of Health Plans believes this bill places an administrative
burden on plans which would be reflected in higher premiums for
consumers. Western Dental Services, Inc., contends this bill
would require the plan to inundate their contracting dentists
with volumes of information about changes, even if they are
unrelated to their contract with the plan, which would have to
be reviewed, considered, and reacted to for each one. The
California Association of Dental Plans (CADP) states that this
bill would single out dental care service plans and dental
insurers to comply with more extensive notice requirements than
required by current law for all health plans and health insurers
in the Health Care Providers' Bill of Rights. According to
CADP, recent amendment attempt to provide guidance to the types
of changes that would trigger notice, but the words "not limited
to" leave the flood gates wide open for dentists to be given
notice of any and all changes, whether material or not.
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097
FN: 0003972