CDA-sponsored legislation that further increases dental plan transparency became law on Jan. 1. AB 954, authored by Assemblymember Jim Wood, DDS, and signed in October by Gov. Gavin Newsom, requires dental plans to be more transparent about the leasing of dental networks. The new law will reduce patient and dentist confusion caused by the increasing number of plans leasing their networks to other payers, many times unbeknownst to the enrollee or contracted dentist(s).
The law took effect for contracts entered into on or after Jan. 1, 2020. Through the provisions outlined in AB 954, the contractual information provided will enhance clarity for patients and dentists on the patient’s potential out-of-pocket costs while protecting the dentist-patient relationship through a more informed treatment planning process.
Under the law’s provisions:
- Dental plans are required to name the parties that will have access to a provider contract.
- Dentists have the ability to opt out of having their existing provider agreement leased to other entities without impacting their original plan contract.
- Dental plans are required maintain an up-to-date website list of all third parties that have access to a provider network contract and to update that information at least once every 90 days.
- Dental plan agreements must clearly identify in specified language and font the contractual clause that allows network leasing.
- Dental plans are required to identify the source of the discount on all written or electronic remittance and the name of the plan that the dentist has a direct contract with.
- Any third-party’s right to a provider discounted rate ceases as of the termination date of the direct provider contract.
- The plan with which the dentist has a direct contract must provide a copy of the provider network contract within 30 days of a provider’s request.
Medicare or Medicaid dental plan agreements are exempt from the requirements of the law.
CDA’s ability to advocate for its members comes directly from member-reported challenges with dental benefit plans. Members and their staff can use our online Dental Benefits Issue Submission Form to submit a question, and an expert analyst will evaluate it for possible resolution and communicate clear next steps.