General Provisions

Cal. INS § 10120.35

California Statutes

(

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 to prevent the spread of diseases causing public health 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) 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. (

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 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 of Division of Title of the Government Code). (

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 insured’s 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. (

f) This

section shall not apply to a Medi-Cal managed care plan that contracts with the State Department of Health Care Services pursuant to

Chapter 7 (commencing with

Section 14000) of,

Chapter 8 (commencing with

Section 14200) of, or

Chapter 8.75 (commencing with

Section 14591) of, Part of Division of the Welfare and Institutions Code.

Document details

CollectionCalifornia Statutes
CitationCal. INS § 10120.35
Date2022-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierINS10120.35.20215382

General Provisions

Cal. INS § 10120.35

California Statutes

General Provisions

Cal. INS § 10120.35

California Statutes

(

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 to prevent the spread of diseases causing public health 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) 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. (

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 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 of Division of Title of the Government Code). (

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 insured’s 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. (

f) This

section shall not apply to a Medi-Cal managed care plan that contracts with the State Department of Health Care Services pursuant to

Chapter 7 (commencing with

Section 14000) of,

Chapter 8 (commencing with

Section 14200) of, or

Chapter 8.75 (commencing with

Section 14591) of, Part of Division of the Welfare and Institutions Code.

Document details

CollectionCalifornia Statutes
CitationCal. INS § 10120.35
Date2022-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierINS10120.35.20215382