Dental coverage.

Assembly Member Haney's dental coverage legislation establishes new requirements for health plans and insurers to expedite access to dental care while expanding payment options for out-of-network providers. The bill reduces maximum wait times for dental appointments, requiring urgent care visits within 48 hours, routine appointments within 18 business days, and preventive care within 20 business days.

The legislation mandates that health plans and insurers pay non-contracted dental providers directly when patients sign an assignment of benefits form. Before accepting such assignments, providers must inform patients of their out-of-network status, note that in-network care may cost less, and provide cost estimates for planned treatments. Plans must notify patients when out-of-network payments are made and explain how these costs apply to annual or lifetime maximums.

To ensure adequate access to care, the bill subjects dental providers to geographic accessibility standards and requires plans to report comprehensive network data, including coverage details across all lines of business. Regulatory departments must evaluate entire provider networks, including portions serving plans they don't directly oversee. The departments may develop additional access standards through 2028, with requirements to consult stakeholders during development.

The provisions exclude Medi-Cal managed care contracts and dental plans. Violations by health plans constitute a crime under state law, though local agencies and school districts require no reimbursement for associated costs since the changes only affect criminal penalties.