BILL ANALYSIS Ó Senate Appropriations Committee Fiscal Summary Senator Christine Kehoe, Chair AB 2252 (Gordon) - Dental coverage: provider notice of changes. Amended: August 6, 2012 Policy Vote: Health 9-0 Urgency: No Mandate: Yes Hearing Date: August 6, 2012 Consultant: Brendan McCarthy This bill does not meet the criteria for referral to the Suspense File. Bill Summary: AB 2252 would require additional notification to dental providers when a health plan or insurer covering dental services makes material changes to rules, guidelines, coverage, or payments. Fiscal Impact: The Department of Managed Health Care may incur one-time costs up to $70,000 (Managed Care Fund) to review health plan documents. Costs to the Department of Insurance are likely to be minor. No increase in costs to the state as a provider of dental benefits is likely to occur, as the changes in the bill are not anticipated to significantly increase the costs of providing dental coverage. Background: Under current state law, health plans are regulated by the Department of Managed Health Care while health insurers are regulated by the Department of Insurance. Current law requires health plans and insurers to provide notification to providers within certain time periods if material changes have been made to a manual, policy, or procedure document, unless the change has already first been negotiated with the provider. Proposed Law: AB 2252 requires health plans and insurers that cover dental services to provide 45 days' notice of any material change to rules, guidelines, policies or procedures of the plan or policy. Notification can be made electronically or by facsimile. For health plans and insurers that automatically renew contracts AB 2252 (Gordon) Page 1 annually, the bill requires the health plan or insurer to make available to the provider, upon request and within 60 days, a copy of the contract and a summary of the changes. The provisions of the bill do not apply to health plans or insurers that contract with two or fewer medical groups Staff Comments: Because the only costs that may be incurred by a local government agency relate to crimes or infractions, the bill does not create a reimbursable state mandate. The recently adopted Author Amendments: narrow the notification requirements and delete any change to the existing statutory definition of "material" as it relates to changes to a provider contract.