CaliforniaDental providers: fee-based payments.
What it does
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act's requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes specified coverage and disclosure requirements on health care service plans and health insurers, including specialized plans and insurers, that cover dental services.
More detail
This bill would require a health care service plan or health insurer that provides payment directly or through a contracted vendor to a dental provider to have a non-fee-based default method of payment, as specified. The bill would require a health care service plan, health insurer, or contracted vendor to obtain affirmative consent from a dental provider who opts in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider. The bill would authorize a dental provider to opt out of a fee-based payment method at any time by providing affirmative consent to the health care service plan, health insurer, or contracted vendor. The bill would require a health care service plan, health insurer, or contracted vendor that obtains affirmative consent to opt in or opt out of fee-based payment to apply the decision to include both the dental provider's entire practice and all products or services covered pursuant to a contract with the dental provider, as specified. The bill would specify that its provisions do not apply if a health care service plan or health insurer has a direct contract with a provider that allows the provider to choose payment methods, including a non-fee-based payment method for services rendered. The bill would make its provisions operative on April 1, 2026, and apply to health care service plan contracts and health insurance policies issued, amended, or renewed on or after that date.
Because a violation of the bill's requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
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Where it stands
- Introduced
- Passed Senate
- Passed Assembly
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2025
- Oct 1Chaptered by Secretary of State. Chapter 219, Statutes of 2025.Latest
- Oct 1Approved by the Governor Gavin Newsom.Became Law
- Sep 16Enrolled and presented to the Governor at 3 p.m.To Governor
- Sep 9Assembly amendments concurred in. (Ayes 40. Noes 0. Page 2714.) Ordered to engrossing and enrolling.Major
- Vote recorded Unfinished Business SB386 Limón Concurrence. Result: pass.Upper
- Sep 8In Senate. Concurrence in Assembly amendments pending.
- Vote recorded SB 386 Limón Senate Third Reading By Sharp-Collins. Result: pass.Lower
- Sep 8Read third time. Passed. (Ayes 79. Noes 0. Page 2978.) Ordered to the Senate.Passed Assembly
- Aug 21Ordered to third reading.Minor
- Aug 21Read third time and amended.Major
- Jul 7Ordered to third reading.Minor
- Jul 7From consent calendar on motion of Assembly Member Garcia.
- Jul 3Read second time. Ordered to consent calendar.Minor
- Jul 2From committee: Do pass. Ordered to consent calendar. (Ayes 14. Noes 0.) (July 2).Minor
- Vote recorded Do pass. To Consent Calendar. Result: pass.Lower
- Jun 17From committee: Do pass and re-refer to Com. on APPR. with recommendation: To consent calendar. (Ayes 15. Noes 0.) (June 17). Re-referred to Com. on APPR.Minor
- Vote recorded Do pass and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar. Result: pass.Lower
- Jun 9Referred to Com. on HEALTH.Minor
- Jun 3In Assembly. Read first time. Held at Desk.Minor
- Jun 2Read third time. Passed. (Ayes 38. Noes 0. Page 1384.) Ordered to the Assembly.Passed Senate
- Vote recorded 3rd Reading. Result: pass.Upper
- Apr 22Read second time. Ordered to third reading.Minor
- Apr 21From committee: Be ordered to second reading pursuant to Senate Rule 28.8.Minor
- Apr 8Set for hearing April 21.
- Apr 7Read second time and amended. Re-referred to Com. on APPR.Major
- Apr 3From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 0. Page 636.) (April 2).Major
- Apr 2
- Vote recorded Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations]. Result: pass.Upper
- Mar 25Set for hearing April 2.
- Mar 18From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.Major
- Feb 26Referred to Com. on HEALTH.Minor
- Feb 18From printer. May be acted upon on or after March 17.
- Feb 14Introduced. Read first time. To Com. on RLS. for assignment. To print.Introduced