Today's Law As Amended


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SB-242 Health care provider reimbursements.(2021-2022)



As Amends the Law Today


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.
(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 provider’s 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.
(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 to implement this section.
(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 enrollee’s health care service plan.

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.
(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 provider’s 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.
(d) 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 to implement this section.
(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 insured’s health insurer.
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.
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.