Dental coverage: provider notice of changes.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act) , 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 a crime. Under the Knox-Keene Act, the Health Care Providers' Bill of Rights prohibits a contract between a health care service plan and a health care provider from including a term authorizing the plan to change a material term of the contract unless the parties have agreed to it or it is required to comply with state or federal law or with accreditation requirements of a private sector accreditation organization. Under existing law, if a change is made by amending a manual, policy, or procedure document referenced in the contract between a plan and a provider, the plan is required to provide at least 45 business days' notice to the provider, as specified. This bill would require a plan providing dental coverage that automatically renews dental provider contracts to annually make available, as specified, to the provider, within 60 days following a request by the provider, a copy of its current contract and a summary of all of those changes made since the contract was issued or last renewed. The bill would also require a plan providing dental coverage to provide at least 45 business days' notice to dentists providing services under its plan contracts of any material change to the plan's rules, guidelines, policies, or procedures concerning dental provider contracting or coverage of or payment for dental services, as specified. Because a willful violation of these requirements would be a crime, the bill would impose a state-mandated local program. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law authorizes health insurers to contract with providers for alternative rates of payment and authorizes the contract to contain provisions permitting a material change to the contract if the insurer provides at least 45 business days' notice to the provider and the provider has the right to terminate the contract prior to implementation of the change. This bill would require an insurer providing dental coverage that automatically renews dental provider contracts to annually make available, as specified, to the provider, within 60 days following a request by the provider, a copy of its current contract and a summary of all those changes made since the contract was issued or last renewed. The bill would also require an insurer providing dental coverage to provide at least 45 business days' notice to dentists contracting with the insurer to provide services under its health insurance policies of any material change to the insurer's rules, guidelines, policies, or procedures concerning dental provider contracting or coverage of or payment for dental services, as specified. 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.