Dental coverage.

Assembly Member Haney's dental care access legislation establishes new requirements for health plans and insurers to ensure timely access to dental services and direct payment to out-of-network providers. The bill sets specific appointment availability standards, requiring dental plans to offer urgent care within 48 hours, non-urgent care within 18 business days, and preventive care appointments within 20 business days of request. Plans must also ensure dentists are available within 15 miles or 30 minutes of enrollees' homes or workplaces.

The legislation requires health plans and insurers that typically pay contracted dental providers directly to extend direct payment to non-contracted providers when patients submit signed assignment of benefits forms. Before accepting these assignments, non-contracted providers must inform patients of their out-of-network status and potential cost implications. Plans must provide prior authorizations to these providers and reimburse at least the pre-authorized amount, except in cases of fraud, billing errors, or coverage loss.

To enable oversight of these requirements, plans must report comprehensive information about their dental networks, including self-insured networks and covered lives across all lines of business. The Department of Managed Health Care and Department of Insurance will review network adequacy across entire dental provider networks, including portions serving plans not under their direct regulation. The departments may investigate non-compliance and assess administrative penalties, with enforcement authority extending beyond December 31, 2025.