Amended IN Assembly August 16, 2021 Amended IN Senate April 13, 2021 Amended IN Senate March 15, 2021 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Senate Bill No. 242Introduced by Senator Newman(Coauthors: Senators Hueso and Wiener)(Coauthors: Assembly Members Robert Rivas and Stone)January 21, 2021 An act to add Section 1374.192 to the Health and Safety Code, and to add Section 10120.35 to the Insurance Code, relating to health care, and declaring the urgency thereof, to take effect immediately. care.LEGISLATIVE COUNSEL'S DIGESTSB 242, as amended, Newman. Health care provider reimbursements.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 provides for the regulation of health insurers by the Department of Insurance. Existing law authorizes a health care service plan or health insurer to contract with a provider for alternative rates of payment.This bill would require a health care service plan or health insurer to contract with its health care providers to reimburse, at a reasonable rate, reimburse contracting health care providers for their business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of respiratory-transmitted infectious diseases causing public health emergencies. emergencies declared on or after January 1, 2022. Because a willful violation of the bills requirements relative to health care service plans 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.This bill would declare that it is to take effect immediately as an urgency statute.Digest Key Vote: TWO_THIRDSMAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1374.192 is added to the Health and Safety Code, to read:1374.192. (a) Notwithstanding any other law, a health care service plan, including a specialized health care service plan and a health care service plan that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).(b)(1)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the plan and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.(2)A health care service plan may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(b) A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per enrollee for the duration of the public health emergency.(c) A change to a contract between a health care service plan and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health care service plan shall not delegate the financial risk to a contracted health care provider for the cost of enrollee services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 1375.7.(d) The department shall ensure a health care service plan provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(e) For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the enrollees health care service plan. The term contracting health care provider only applies to a dentist if the enrollee is covered by a health care service plan contract or specialized health care service plan contract that includes dental benefits.(f) This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.SEC. 2. Section 10120.35 is added to the Insurance Code, to read:10120.35. (a) Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).(b)(1)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the insurer and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.(2)A health insurer may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(c)A change to a contract between a health insurer and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health insurer shall not delegate the financial risk to a contracted health care provider for the cost of insured services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 10133.65.(b) A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per insured for the duration of the public health emergency.(d)(c) The department shall ensure a health insurer provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(e)(d) For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the insureds health insurer. The term contracting health care provider only applies to a dentist if the insured is covered by a health insurance policy or specialized health insurance policy that includes dental benefits.(e) This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:To protect the health of frontline medical and dental personnel, which ensures the ongoing availability of medical and dental practices, thus safeguarding access to care, and due to the paradigm shift increasing the level of expectation of infection control protocols during, and likely following, the COVID-19 pandemic, it is necessary for this act to take effect immediately.
Amended IN Assembly August 16, 2021 Amended IN Senate April 13, 2021 Amended IN Senate March 15, 2021 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Senate Bill No. 242Introduced by Senator Newman(Coauthors: Senators Hueso and Wiener)(Coauthors: Assembly Members Robert Rivas and Stone)January 21, 2021 An act to add Section 1374.192 to the Health and Safety Code, and to add Section 10120.35 to the Insurance Code, relating to health care, and declaring the urgency thereof, to take effect immediately. care.LEGISLATIVE COUNSEL'S DIGESTSB 242, as amended, Newman. Health care provider reimbursements.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 provides for the regulation of health insurers by the Department of Insurance. Existing law authorizes a health care service plan or health insurer to contract with a provider for alternative rates of payment.This bill would require a health care service plan or health insurer to contract with its health care providers to reimburse, at a reasonable rate, reimburse contracting health care providers for their business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of respiratory-transmitted infectious diseases causing public health emergencies. emergencies declared on or after January 1, 2022. Because a willful violation of the bills requirements relative to health care service plans 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.This bill would declare that it is to take effect immediately as an urgency statute.Digest Key Vote: TWO_THIRDSMAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES
Amended IN Assembly August 16, 2021 Amended IN Senate April 13, 2021 Amended IN Senate March 15, 2021
Amended IN Assembly August 16, 2021
Amended IN Senate April 13, 2021
Amended IN Senate March 15, 2021
CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION
Senate Bill
No. 242
Introduced by Senator Newman(Coauthors: Senators Hueso and Wiener)(Coauthors: Assembly Members Robert Rivas and Stone)January 21, 2021
Introduced by Senator Newman(Coauthors: Senators Hueso and Wiener)(Coauthors: Assembly Members Robert Rivas and Stone)
January 21, 2021
An act to add Section 1374.192 to the Health and Safety Code, and to add Section 10120.35 to the Insurance Code, relating to health care, and declaring the urgency thereof, to take effect immediately. care.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
SB 242, as amended, Newman. Health care provider reimbursements.
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 provides for the regulation of health insurers by the Department of Insurance. Existing law authorizes a health care service plan or health insurer to contract with a provider for alternative rates of payment.This bill would require a health care service plan or health insurer to contract with its health care providers to reimburse, at a reasonable rate, reimburse contracting health care providers for their business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of respiratory-transmitted infectious diseases causing public health emergencies. emergencies declared on or after January 1, 2022. Because a willful violation of the bills requirements relative to health care service plans 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.This bill would declare that it is to take effect immediately as an urgency statute.
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 provides for the regulation of health insurers by the Department of Insurance. Existing law authorizes a health care service plan or health insurer to contract with a provider for alternative rates of payment.
This bill would require a health care service plan or health insurer to contract with its health care providers to reimburse, at a reasonable rate, reimburse contracting health care providers for their business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of respiratory-transmitted infectious diseases causing public health emergencies. emergencies declared on or after January 1, 2022. Because a willful violation of the bills requirements relative to health care service plans 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.
This bill would declare that it is to take effect immediately as an urgency statute.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 1374.192 is added to the Health and Safety Code, to read:1374.192. (a) Notwithstanding any other law, a health care service plan, including a specialized health care service plan and a health care service plan that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).(b)(1)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the plan and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.(2)A health care service plan may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(b) A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per enrollee for the duration of the public health emergency.(c) A change to a contract between a health care service plan and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health care service plan shall not delegate the financial risk to a contracted health care provider for the cost of enrollee services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 1375.7.(d) The department shall ensure a health care service plan provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(e) For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the enrollees health care service plan. The term contracting health care provider only applies to a dentist if the enrollee is covered by a health care service plan contract or specialized health care service plan contract that includes dental benefits.(f) This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.SEC. 2. Section 10120.35 is added to the Insurance Code, to read:10120.35. (a) Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).(b)(1)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the insurer and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.(2)A health insurer may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(c)A change to a contract between a health insurer and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health insurer shall not delegate the financial risk to a contracted health care provider for the cost of insured services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 10133.65.(b) A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per insured for the duration of the public health emergency.(d)(c) The department shall ensure a health insurer provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(e)(d) For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the insureds health insurer. The term contracting health care provider only applies to a dentist if the insured is covered by a health insurance policy or specialized health insurance policy that includes dental benefits.(e) This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:To protect the health of frontline medical and dental personnel, which ensures the ongoing availability of medical and dental practices, thus safeguarding access to care, and due to the paradigm shift increasing the level of expectation of infection control protocols during, and likely following, the COVID-19 pandemic, it is necessary for this act to take effect immediately.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. Section 1374.192 is added to the Health and Safety Code, to read:1374.192. (a) Notwithstanding any other law, a health care service plan, including a specialized health care service plan and a health care service plan that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).(b)(1)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the plan and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.(2)A health care service plan may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(b) A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per enrollee for the duration of the public health emergency.(c) A change to a contract between a health care service plan and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health care service plan shall not delegate the financial risk to a contracted health care provider for the cost of enrollee services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 1375.7.(d) The department shall ensure a health care service plan provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(e) For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the enrollees health care service plan. The term contracting health care provider only applies to a dentist if the enrollee is covered by a health care service plan contract or specialized health care service plan contract that includes dental benefits.(f) This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
SECTION 1. Section 1374.192 is added to the Health and Safety Code, to read:
### SECTION 1.
1374.192. (a) Notwithstanding any other law, a health care service plan, including a specialized health care service plan and a health care service plan that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).(b)(1)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the plan and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.(2)A health care service plan may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(b) A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per enrollee for the duration of the public health emergency.(c) A change to a contract between a health care service plan and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health care service plan shall not delegate the financial risk to a contracted health care provider for the cost of enrollee services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 1375.7.(d) The department shall ensure a health care service plan provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(e) For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the enrollees health care service plan. The term contracting health care provider only applies to a dentist if the enrollee is covered by a health care service plan contract or specialized health care service plan contract that includes dental benefits.(f) This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
1374.192. (a) Notwithstanding any other law, a health care service plan, including a specialized health care service plan and a health care service plan that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).(b)(1)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the plan and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.(2)A health care service plan may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(b) A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per enrollee for the duration of the public health emergency.(c) A change to a contract between a health care service plan and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health care service plan shall not delegate the financial risk to a contracted health care provider for the cost of enrollee services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 1375.7.(d) The department shall ensure a health care service plan provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(e) For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the enrollees health care service plan. The term contracting health care provider only applies to a dentist if the enrollee is covered by a health care service plan contract or specialized health care service plan contract that includes dental benefits.(f) This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
1374.192. (a) Notwithstanding any other law, a health care service plan, including a specialized health care service plan and a health care service plan that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).(b)(1)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the plan and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.(2)A health care service plan may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(b) A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per enrollee for the duration of the public health emergency.(c) A change to a contract between a health care service plan and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health care service plan shall not delegate the financial risk to a contracted health care provider for the cost of enrollee services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 1375.7.(d) The department shall ensure a health care service plan provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(e) For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the enrollees health care service plan. The term contracting health care provider only applies to a dentist if the enrollee is covered by a health care service plan contract or specialized health care service plan contract that includes dental benefits.(f) This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
1374.192. (a) Notwithstanding any other law, a health care service plan, including a specialized health care service plan and a health care service plan that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).
(b)(1)A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the plan and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.
(2)A health care service plan may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.
(b) A health care service plan shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per enrollee for the duration of the public health emergency.
(c) A change to a contract between a health care service plan and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health care service plan shall not delegate the financial risk to a contracted health care provider for the cost of enrollee services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 1375.7.
(d) The department shall ensure a health care service plan provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(e) For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the enrollees health care service plan. The term contracting health care provider only applies to a dentist if the enrollee is covered by a health care service plan contract or specialized health care service plan contract that includes dental benefits.
(f) This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
SEC. 2. Section 10120.35 is added to the Insurance Code, to read:10120.35. (a) Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).(b)(1)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the insurer and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.(2)A health insurer may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(c)A change to a contract between a health insurer and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health insurer shall not delegate the financial risk to a contracted health care provider for the cost of insured services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 10133.65.(b) A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per insured for the duration of the public health emergency.(d)(c) The department shall ensure a health insurer provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(e)(d) For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the insureds health insurer. The term contracting health care provider only applies to a dentist if the insured is covered by a health insurance policy or specialized health insurance policy that includes dental benefits.(e) This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
SEC. 2. Section 10120.35 is added to the Insurance Code, to read:
### SEC. 2.
10120.35. (a) Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).(b)(1)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the insurer and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.(2)A health insurer may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(c)A change to a contract between a health insurer and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health insurer shall not delegate the financial risk to a contracted health care provider for the cost of insured services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 10133.65.(b) A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per insured for the duration of the public health emergency.(d)(c) The department shall ensure a health insurer provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(e)(d) For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the insureds health insurer. The term contracting health care provider only applies to a dentist if the insured is covered by a health insurance policy or specialized health insurance policy that includes dental benefits.(e) This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
10120.35. (a) Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).(b)(1)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the insurer and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.(2)A health insurer may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(c)A change to a contract between a health insurer and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health insurer shall not delegate the financial risk to a contracted health care provider for the cost of insured services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 10133.65.(b) A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per insured for the duration of the public health emergency.(d)(c) The department shall ensure a health insurer provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(e)(d) For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the insureds health insurer. The term contracting health care provider only applies to a dentist if the insured is covered by a health insurance policy or specialized health insurance policy that includes dental benefits.(e) This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
10120.35. (a) Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).(b)(1)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the insurer and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.(2)A health insurer may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.(c)A change to a contract between a health insurer and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health insurer shall not delegate the financial risk to a contracted health care provider for the cost of insured services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 10133.65.(b) A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per insured for the duration of the public health emergency.(d)(c) The department shall ensure a health insurer provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(e)(d) For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the insureds health insurer. The term contracting health care provider only applies to a dentist if the insured is covered by a health insurance policy or specialized health insurance policy that includes dental benefits.(e) This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
10120.35. (a) Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a contract covering dental services, shall reimburse its contracting health care providers for business expenses that are medically necessary to comply with a public health order to render treatment to patients, to protect health care workers, and to prevent the spread of diseases causing public health emergencies, including COVID-19. These medically necessary business expenses include personal protective equipment, infection control supplies or materials, medical testing supplies, test processing, the cost of transporting specimens, information technology systems for tracking infections and processing testing. emergencies declared on or after January 1, 2022. For purposes of this subdivision, business expenses means personal protective equipment, additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other nonfacility service or services if performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease and pursuant to subdivision (b).
(b)(1)A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) at a reasonable rate negotiated by the insurer and provider for the duration of the public health emergency, or until the contract is renegotiated. Reimbursement shall be based on the providers description of these services on the claim. The reimbursement rate paid to dental providers shall be comparable to the rate paid to other health care providers.
(2)A health insurer may provide supplemental payments to a contracting health care provider to purchase personal protective equipment, infection control supplies or materials, testing supplies, test processing, test specimen transport, or other medical equipment.
(c)A change to a contract between a health insurer and a health care provider that delegates financial risk for testing, including related items and services, related to a public health emergency declared pursuant to Section 8558 of the Government Code is a material change to the parties contract. A health insurer shall not delegate the financial risk to a contracted health care provider for the cost of insured services provided under this section unless the parties have negotiated and agreed upon a new contract provision pursuant to Section 10133.65.
(b) A health insurer shall reimburse a contracting health care provider pursuant to subdivision (a) for each individual patient encounter, limited to one encounter per day per insured for the duration of the public health emergency.
(d)
(c) The department shall ensure a health insurer provides timely reimbursement to its contracting health care providers pursuant to subdivision (a). The department may adopt regulations guidance to implement this section. The guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(e)
(d) For purposes of this section, contracting health care provider means a physician and surgeon, dentist, or doctor of podiatric medicine who is licensed by the state to deliver or furnish health care services, who owns or operates a practice, and who is contracted with the insureds health insurer. The term contracting health care provider only applies to a dentist if the insured is covered by a health insurance policy or specialized health insurance policy that includes dental benefits.
(e) This section does not apply to the state of emergency declared by the Governor on March 4, 2020, relating to the coronavirus 2019 (COVID-19) pandemic.
SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
### SEC. 3.
This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
To protect the health of frontline medical and dental personnel, which ensures the ongoing availability of medical and dental practices, thus safeguarding access to care, and due to the paradigm shift increasing the level of expectation of infection control protocols during, and likely following, the COVID-19 pandemic, it is necessary for this act to take effect immediately.