Individual legislator voting records for this vote are not currently available. Includes all politicians who were in office at any point during the 2011-2012 Legislature.

AB 1579 - 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.

Dental coverage: noncontracting providers: assignment of benefits. 2011-2012 Legislature. View bill details
Author(s):
Summary:
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… More
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 specify that a plan or insurer’s payment pursuant to this provision discharges the plan or insurer’s obligation with respect to the amount paid. The bill would also require a noncontracting dental provider to disclose to the enrollee or insured or the legal representative thereof that the provider is a noncontracting provider prior to accepting an assignment of benefits, and to provide additional specified written notices to the enrollee or insured or the legal representative thereof, including a written notice of the estimated full cost of the planned treatment and the estimated amount of those costs payable by the enrollee or insured. The bill would also prohibit a provider from collecting from an enrollee or insured any amount over the enrollee’s or insured’s estimated cost, and would require the provider to refund any overpayment to the enrollee or insured.

Because a willful violation of the bill’s requirements with respect 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. Hide
 
Status:
The bill was voted on by the Assembly on May 14, 2012. 
Assembly Vote: On Passage

PASSED on May 14, 2012.

voted YES: 74 voted NO: 1
5 voted present/not voting

Other Votes:

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.

AB 1579 — 2011-2012 Legislature

Summary
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… More
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 specify that a plan or insurer’s payment pursuant to this provision discharges the plan or insurer’s obligation with respect to the amount paid. The bill would also require a noncontracting dental provider to disclose to the enrollee or insured or the legal representative thereof that the provider is a noncontracting provider prior to accepting an assignment of benefits, and to provide additional specified written notices to the enrollee or insured or the legal representative thereof, including a written notice of the estimated full cost of the planned treatment and the estimated amount of those costs payable by the enrollee or insured. The bill would also prohibit a provider from collecting from an enrollee or insured any amount over the enrollee’s or insured’s estimated cost, and would require the provider to refund any overpayment to the enrollee or insured.

Because a willful violation of the bill’s requirements with respect 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. Hide
Learn More
At LegInfo.ca.gov
Title
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.
Author(s)
Nora Campos
Co-Authors
    Subjects
    • Dental coverage: noncontracting providers: assignment of benefits
    Major Actions
    Introduced2/02/2012
    Referred to Committee
    Passed Assembly Committee on Health4/24/2012
    Passed Assembly Committee on Appropriations5/09/2012
    Passed Assembly5/14/2012
    Bill History
    Chamber/CommitteeMotionDateResult
    select this voteAssembly Committee on HealthDo pass and be re-referred to the Committee on Appropriations.4/24/2012This motion PASSED the Assembly Committee on Health
    19 voted YES 0 voted NO 0 voted present/not voting
    select this voteAssembly Committee on AppropriationsDo pass.5/09/2012This motion PASSED the Assembly Committee on Appropriations
    16 voted YES 0 voted NO 1 voted present/not voting
    currently selectedAssemblyAB 1579 CAMPOS Assembly Third Reading5/14/2012This bill PASSED the Assembly
    74 voted YES 1 voted NO 5 voted present/not voting
    ActionDateDescription
    Introduced2/02/2012
    2/02/2012Read first time. To print.
    2/03/2012From printer. May be heard in committee March 4.
    2/17/2012Referred to Com. on HEALTH.
    3/20/2012From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.
    3/21/2012Re-referred to Com. on HEALTH.
    3/27/2012In committee: Set, first hearing. Hearing canceled at the request of author.
    4/23/2012From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.
    4/24/2012Re-referred to Com. on HEALTH.
    select this voteVote4/24/2012Do pass and be re-referred to the Committee on Appropriations.
    4/25/2012From committee: Do pass and re-refer to Com. on APPR. (Ayes 19. Noes 0.) (April 24). Re-referred to Com. on APPR.
    5/09/2012From committee: Do pass. (Ayes 16. Noes 0.) (May 9).
    select this voteVote5/09/2012Do pass.
    5/10/2012Read second time. Ordered to third reading.
    5/14/2012Read third time. Passed. Ordered to the Senate. (Ayes 74. Noes 1. Page 4822.)
    5/14/2012In Senate. Read first time. To Com. on RLS. for assignment.
    currently selectedAssembly Vote on Passage5/14/2012AB 1579 CAMPOS Assembly Third Reading
    5/24/2012Referred to Com. on HEALTH.
    6/13/2012In committee: Set, first hearing. Hearing canceled at the request of author.

    Total contributions given to Assemblymembers from interest groups that…

    supported this bill

    $379,100
    $379,100
    139% more
    $38,750
    $600,150
    $266,422
    $905,322
    2 Organizations Supported and 5 Opposed; See Which Ones

    Organizations that took a position on
    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.: AB 1579 CAMPOS Assembly Third Reading

    2 organizations supported this bill

    California Dental Association
    Assembly Committee on Health (2012, March 23). Assembly Committee Analysis. Retrieved May 29, 2012, from Leginfo: Bill Analysis.
    Western Dental Services, Inc.
    Assembly Committee on Health (2012, April 23). Assembly Committee Analysis. Retrieved July 2, 2012, from Leginfo: Bill Analysis.

    5 organizations opposed this bill

    America's Health Insurance Plans
    Assembly Committee on Health (2012, March 23). Assembly Committee Analysis. Retrieved May 29, 2012, from Leginfo: Bill Analysis.
    Association of California Life and Health Insurance Companies
    Assembly Committee on Health (2012, March 23). Assembly Committee Analysis. Retrieved May 29, 2012, from Leginfo: Bill Analysis.
    California Association of Dental Plans
    Assembly Committee on Health (2012, March 23). Assembly Committee Analysis. Retrieved May 29, 2012, from Leginfo: Bill Analysis.
    California Association of Health Plans
    Assembly Committee on Health (2012, March 23). Assembly Committee Analysis. Retrieved May 29, 2012, from Leginfo: Bill Analysis.
    Delta Dental
    Assembly Committee on Health (2012, March 23). Assembly Committee Analysis. Retrieved May 29, 2012, from Leginfo: Bill Analysis.

    Need proof?

    View citations of support and opposition

    Includes reported contributions to campaigns of Assemblymembers in office on day of vote, from interest groups invested in the vote according to MapLight, January 1, 2011 – December 31, 2012.
    Contributions data source: FollowTheMoney.org

    Contributions by Legislator

    Namesort iconPartyDistrict$ From Interest Groups
    That Supported
    $ From Interest Groups
    That Opposed
    Vote
    Katcho AchadjianRCA-33$5,000$10,750
    Luis AlejoDCA-28$3,500$3,500
    Michael AllenDCA-7$4,300$3,200
    Tom AmmianoDCA-13$0$350
    Toni AtkinsDCA-76$17,250$29,350
    Jim BeallDCA-24$5,900$6,575
    Bill BerryhillRCA-26$9,700$15,400
    Marty BlockDCA-78$15,600$5,400
    Bob BlumenfieldDCA-40$4,500$5,000
    Susan BonillaDCA-11$18,000$20,700
    Steven BradfordDCA-51$0$8,000
    Julia BrownleyDCA-41$0$0
    Joan BuchananDCA-15$11,700$10,400
    Betsy ButlerDCA-53$17,100$8,150
    Charles CalderonDCA-58$0$0
    Nora CamposDCA-23$13,950$3,500
    Wilmer Amina CarterDCA-62$0$0
    Gilbert CedilloDCA-45$0$0
    Wesley ChesbroDCA-1$5,500$5,900
    Connie ConwayRCA-34$15,700$58,931
    Paul CookRCA-65$0$0
    Mike DavisDCA-48$0$0
    Roger DickinsonDCA-9$1,000$8,000
    Tim DonnellyRCA-59$0$250
    Mike EngDCA-49$0$0
    Mike FeuerDCA-42$0$0
    Nathan FletcherRCA-75$0$0
    Paul FongDCA-22$5,150$250
    Felipe FuentesDCA-39$0$0
    Warren FurutaniDCA-55$0$0
    Beth GainesRCA-4$7,850$31,071
    Cathleen GalgianiDCA-17$1,500$22,300
    Martin GarrickRCA-74$0$0
    Mike GattoDCA-43$13,800$38,225
    Rich GordonDCA-21$18,100$20,850
    Jeff GorellRCA-37$3,900$11,400
    Shannon GroveRCA-32$0$8,000
    Curt HagmanRCA-60$7,500$13,000
    Linda HaldermanRCA-29$0$0
    Isadore HallDCA-52$0$22,803
    Diane HarkeyRCA-73$0$16,100
    Mary HayashiDCA-18$0$0
    Roger HernandezDCA-57$5,500$24,330
    Jerry HillDCA-19$2,000$19,500
    Alyson HuberDCA-10$0$0
    Ben HuesoDCA-79$7,000$5,500
    Jared HuffmanDCA-6$0$0
    Kevin JeffriesRCA-66$0$0
    Brian JonesRCA-77$2,500$1,500
    Steve KnightRCA-36$0$7,500
    Ricardo LaraDCA-50$15,600$20,800
    Dan LogueRCA-3$8,700$56,029
    Bonnie LowenthalDCA-54$2,000$5,000
    Fiona MaDCA-12$0$0
    Allan MansoorRCA-68$3,900$17,300
    Tony MendozaDCA-56$0$0
    Jeff MillerRCA-71$3,900$19,550
    Holly MitchellDCA-47$17,500$16,950
    Bill MonningDCA-27$8,900$43,011
    Mike MorrellRCA-63$0$14,550
    Brian NestandeRCA-64$10,900$22,300
    Jim NielsenRCA-2$3,900$3,000
    Chris NorbyRCA-72$2,000$14,750
    Kristin OlsenRCA-25$6,900$23,475
    Richard PanDCA-5$18,600$64,499
    Henry PereaDCA-31$9,800$33,400
    John PerezDCA-46$20,600$60,773
    Manuel PerezDCA-80$6,600$12,400
    Anthony PortantinoDCA-44$0$0
    Jim SilvaRCA-67$0$0
    Nancy SkinnerDCA-14$7,800$5,600
    Cameron SmythRCA-38$0$0
    Jose SolorioDCA-69$0$0
    Sandre SwansonDCA-16$0$0
    Norma TorresDCA-61$1,000$4,500
    David ValadaoRCA-30$0$0
    Don WagnerRCA-70$0$4,600
    Bob WieckowskiDCA-20$3,000$3,750
    Das WilliamsDCA-35$4,000$13,400
    Mariko YamadaDCA-8$0$0

    Add Data Filters:

    Legislator Filters
    Legislator Filters
    Show All
    NamePartyDistrict$ From Interest Groups
    That Supported
    $ From Interest Groups
    That Opposed
    Vote
    Katcho AchadjianRCA-33$5,000$10,750
    Luis AlejoDCA-28$3,500$3,500
    Michael AllenDCA-7$4,300$3,200
    Tom AmmianoDCA-13$0$350
    Toni AtkinsDCA-76$17,250$29,350
    Jim BeallDCA-24$5,900$6,575
    Bill BerryhillRCA-26$9,700$15,400
    Marty BlockDCA-78$15,600$5,400
    Bob BlumenfieldDCA-40$4,500$5,000
    Susan BonillaDCA-11$18,000$20,700
    Steven BradfordDCA-51$0$8,000
    Julia BrownleyDCA-41$0$0
    Joan BuchananDCA-15$11,700$10,400
    Betsy ButlerDCA-53$17,100$8,150
    Charles CalderonDCA-58$0$0
    Nora CamposDCA-23$13,950$3,500
    Wilmer Amina CarterDCA-62$0$0
    Gilbert CedilloDCA-45$0$0
    Wesley ChesbroDCA-1$5,500$5,900
    Connie ConwayRCA-34$15,700$58,931
    Paul CookRCA-65$0$0
    Mike DavisDCA-48$0$0
    Roger DickinsonDCA-9$1,000$8,000
    Tim DonnellyRCA-59$0$250
    Mike EngDCA-49$0$0
    Mike FeuerDCA-42$0$0
    Nathan FletcherRCA-75$0$0
    Paul FongDCA-22$5,150$250
    Felipe FuentesDCA-39$0$0
    Warren FurutaniDCA-55$0$0
    Beth GainesRCA-4$7,850$31,071
    Cathleen GalgianiDCA-17$1,500$22,300
    Martin GarrickRCA-74$0$0
    Mike GattoDCA-43$13,800$38,225
    Rich GordonDCA-21$18,100$20,850
    Jeff GorellRCA-37$3,900$11,400
    Shannon GroveRCA-32$0$8,000
    Curt HagmanRCA-60$7,500$13,000
    Linda HaldermanRCA-29$0$0
    Isadore HallDCA-52$0$22,803
    Diane HarkeyRCA-73$0$16,100
    Mary HayashiDCA-18$0$0
    Roger HernandezDCA-57$5,500$24,330
    Jerry HillDCA-19$2,000$19,500
    Alyson HuberDCA-10$0$0
    Ben HuesoDCA-79$7,000$5,500
    Jared HuffmanDCA-6$0$0
    Kevin JeffriesRCA-66$0$0
    Brian JonesRCA-77$2,500$1,500
    Steve KnightRCA-36$0$7,500
    Ricardo LaraDCA-50$15,600$20,800
    Dan LogueRCA-3$8,700$56,029
    Bonnie LowenthalDCA-54$2,000$5,000
    Fiona MaDCA-12$0$0
    Allan MansoorRCA-68$3,900$17,300
    Tony MendozaDCA-56$0$0
    Jeff MillerRCA-71$3,900$19,550
    Holly MitchellDCA-47$17,500$16,950
    Bill MonningDCA-27$8,900$43,011
    Mike MorrellRCA-63$0$14,550
    Brian NestandeRCA-64$10,900$22,300
    Jim NielsenRCA-2$3,900$3,000
    Chris NorbyRCA-72$2,000$14,750
    Kristin OlsenRCA-25$6,900$23,475
    Richard PanDCA-5$18,600$64,499
    Henry PereaDCA-31$9,800$33,400
    John PerezDCA-46$20,600$60,773
    Manuel PerezDCA-80$6,600$12,400
    Anthony PortantinoDCA-44$0$0
    Jim SilvaRCA-67$0$0
    Nancy SkinnerDCA-14$7,800$5,600
    Cameron SmythRCA-38$0$0
    Jose SolorioDCA-69$0$0
    Sandre SwansonDCA-16$0$0
    Norma TorresDCA-61$1,000$4,500
    David ValadaoRCA-30$0$0
    Don WagnerRCA-70$0$4,600
    Bob WieckowskiDCA-20$3,000$3,750
    Das WilliamsDCA-35$4,000$13,400
    Mariko YamadaDCA-8$0$0

    Interest Groups that supported this bill

    $ Donated
    Dentists$379,100

    Interest Groups that opposed this bill

    $ Donated
    Accident & health insurance$600,150
    HMOs$266,422
    Insurance companies, general$38,750
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