Bill Text: CA AB1579 | 2011-2012 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Dental coverage: noncontracting providers: assignment of

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed - Dead) 2012-06-13 - In committee: Set, first hearing. Hearing canceled at the request of author. [AB1579 Detail]

Download: California-2011-AB1579-Introduced.html

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BILL NUMBER: AB 1579	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Campos

                        FEBRUARY 2, 2012

   An act to add Section 1374.196 to the Health and Safety Code, and
to add Section 10120.4 to the Insurance Code, relating to health care
coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1579, as introduced, Campos. Dental coverage: noncontracting
providers: assignment of benefits.
   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 a crime. Existing law also provides for the
regulation of health insurers by the Department of Insurance.
Existing law authorizes licensed nonphysician providers that contract
with a medical group, physician, or independent practice association
to provide services to health care service plan enrollees to
directly bill the plan for services rendered under certain
circumstances. Existing law requires group health care service plans
to authorize and permit assignment of a Medi-Cal beneficiary's right
to reimbursement for covered services to the State Department of
Health Care Services, except as specified. Existing law provides for
the direct payment of group insurance medical benefits by a health
insurer to the person or persons furnishing or paying for
hospitalization or medical or surgical aid, as specified.
   This bill would require a health care service plan or health
insurer that pays a contracting dental provider directly for covered
services rendered to an enrollee or insured to also pay a
noncontracting dental provider directly for covered services rendered
to an enrollee or insured where the provider submits a written
assignment of benefits signed by the enrollee or insured or the legal
representative thereof, as specified. The bill would authorize that
noncontracting dental provider to bill the subscriber or enrollee or
policyholder or insured for any remaining amount due for those
services.
   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.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1374.196 is added to the Health and Safety
Code, to read:
   1374.196.  (a) For purposes of this section, "assignment of
benefits" means the transfer of reimbursement or other rights
provided for under a health care service plan contract to a treating
provider for services or items rendered to an enrollee.
   (b) If a health care service plan pays a contracting dental
provider directly for covered services rendered to an enrollee, the
plan shall pay a noncontracting dental provider directly for covered
services rendered to an enrollee where the noncontracting provider
submits to the plan a written assignment of benefits signed by the
enrollee or, if the enrollee is a minor or is incompetent or
incapacitated, the legal representative thereof. When payment is made
directly to a noncontracting dental provider pursuant to this
section, the plan shall give written notice of the payment to the
enrollee who received the services or, if the enrollee is a minor or
is incompetent or incapacitated, the legal representative thereof.
   (c) A noncontracting dental provider accepting an assignment of
benefits pursuant to this section may bill the individual subscriber
or enrollee for any amount due for services rendered beyond the
amount covered by the plan's fee schedule or specific payment rate.
   (d) This section shall only apply to a health care service plan
contract covering dental services or a specialized health care
service plan contract covering dental services pursuant to this
chapter.
  SEC. 2.  Section 10120.4 is added to the Insurance Code, to read:
   10120.4.  (a) For purposes of this section, "assignment of
benefits" means the transfer of reimbursement or other rights
provided for under a health insurance policy to a treating provider
for services or items rendered to an insured.
   (b) If a health insurer pays a contracting dental provider
directly for covered services rendered to an insured, the insurer
shall pay a noncontracting dental provider directly for covered
services rendered to an insured where the noncontracting provider
submits to the insurer a written assignment of benefits signed by the
insured or, if the insured is a minor or is incompetent or
incapacitated, the legal representative thereof. When payment is made
directly to a noncontracting dental provider pursuant to this
section, the insurer shall give written notice of the payment to the
insured who received the services or, if the insured is a minor or is
incompetent or incapacitated, the legal representative thereof.
   (c) A noncontracting dental provider accepting an assignment of
benefits pursuant to this section may bill the individual
policyholder or insured for any amount due for services rendered
beyond the amount covered by the insurer's fee schedule or specific
payment rate.
   (d) This section shall only apply to a health insurance policy
covering dental services or a specialized health insurance policy
covering dental services pursuant to this part.
  SEC. 3.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.