Dental coverage.

Removed the phrase 'upon written and dated consent of the enrollee or insured' from the requirement that plans and insurers pay noncontracting dental providers directly. The plan's payment obligation is now triggered by the submission of an assignment of benefits, without requiring a separate written consent from the patient to the plan.

Corrected a drafting error in Section 1680(ai)(1) of the Business and Professions Code, changing 'The failure to comply with provide the disclosures' to 'The failure to provide the disclosures.'

Removed the coauthor credit (Assembly Member Addis) from the bill header, which is standard when a bill reaches enrolled status.

Registered dental hygienists in alternative practice are now explicitly included as noncontracting dental providers eligible for direct payment by plans and insurers under the assignment of benefits mechanism.

Section 1950.5 of the Business and Professions Code is added to the list of statutes being amended, likely extending discipline provisions to dental hygienists regulated by the Dental Hygiene Board of California.

Three new disclosure items are required before a noncontracting dental provider can collect an assignment of benefits consent: (1) that plan or policy benefits may not apply to the treatment and the provider is not subject to plan requirements, (2) that the patient has the right to confirm their coverage information before beginning treatment, and (3) that assignment of benefits is optional and may be revoked in writing.

A provision requiring plans or insurers to provide a predetermination or prior authorization directly to the dental provider, reimburse for not less than that amount, and notify the enrollee that out-of-network cost may count toward annual or lifetime maximums is removed from the bill.

Two new unprofessional conduct categories are created under Section 1680: failure to maintain a signed and dated copy of the patient's consent to assignment of benefits, and charging a patient more than an estimate of their cost sharing or a deposit approximating cost share before plan payment.

The mechanism is reframed from a 'written assignment of benefits form signed by the enrollee' to a 'signed and dated consent to collect an assignment of benefits,' shifting emphasis to the patient's consent as the triggering document.

The direct payment requirement for noncontracting dental providers now explicitly applies to 'a specialized plan or insurer' in addition to general health care service plans and insurers, closing a potential gap in coverage.

A new prohibition bars a noncontracting dental provider accepting assignment of benefits from charging an enrollee or insured more than an estimate of their cost sharing (or a deposit approximating that amount) prior to the plan's payment.

The provision requiring the Department of Managed Health Care and the Department of Insurance to jointly review the adequacy of an entire dental provider network, including portions serving plans and insurers not regulated by those departments, was removed from the bill.

A new subdivision (ai) is added to Section 1680 of the Business and Professions Code making it unprofessional conduct for a dentist to fail to comply with Section 1374.191 (Health and Safety Code) or Section 10120.6 (Insurance Code), extending disciplinary reach beyond just the disclosure requirement to cover the payment provisions as well.

The fiscal note was updated to state that no state reimbursement is required for compliance with the payment requirements, the charging prohibition, and the disclosure obligations, reflecting the expanded scope of local program mandates.

New legislative findings section (Section 1) clarifies that the bill is not intended to give the state authority to regulate dental plans or insurers outside its current jurisdiction, while stating the intent to hold them accountable for network adequacy. It also notes that nearly half of Californians with commercial dental plans have self-insured, ASO, or TPA-managed coverage not currently included in the state's network adequacy assessment.

New Section 2 amends Business and Professions Code Section 1680 to add a new ground for unprofessional conduct: a dentist who fails to provide an enrollee or insured with specified disclosures before accepting an assignment of benefits when not under contract with the dental benefit plan. Required disclosures include: (1) that the provider is noncontracting, (2) that out-of-pocket costs may be lower with a contracting dentist, and (3) an estimate of planned treatment cost and the patient's share.

New paragraph in Section 1367.03(f)(5) requires plans to report comprehensive information regarding dental provider networks, including the number of covered lives per line of business (including third-party or administrative service organizations). The department must review the adequacy of an entire dental provider network, including portions serving plans and insurers not regulated by the department.

New paragraph in Health and Safety Code Section 1367.03(f)(5) requires plans to certify under penalty of perjury that network adequacy data submitted to the Department of Managed Health Care is true and correct, including an attestation that the plan evaluated the total number of lives utilizing the same provider network. The department may audit plans for compliance or in response to consumer complaints.

Minor language changes throughout: 'assures' replaced with 'ensures' in two places, a duplicate word 'plan plan' corrected to 'plan,' and section renumbering (original Section 1 becomes Section 3) to accommodate the new findings section and Business and Professions Code amendment.