Department of Managed Health Care Proposes the Formal Adoption of Dental Benefits and Coverage Disclosure Matrix Regulations

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By William Espinosa

On July 23, 2021, the Department of Managed Health Care (DMHC) published notice of rulemaking action pertaining to the formal adoption of section 1300.63.4, Title 28 of the California Code of Regulations (CCR), “Summary of Dental Benefits and Coverage Disclosure Matrix” (SDBC). As provided in the Initial Statement of Reasons, section 1300.63.4 was first adopted on December 29, 2020 as an emergency regulation. The emergency regulation included a uniform benefits and coverage disclosure matrix to be used by health care service plans that cover dental services and provided to consumers for transparency. The emergency regulation outlined the medical providers who would have to provide the matrix, to whom the matrix must be provided, and the acceptable methods of delivery for the matrix. The emergency regulation also provided the matrix itself and the Instruction Guide for SDBC. OAL approved the emergency regulation, and this change became effective on January 25, 2021. [26:2 CRLR 33]

DMHC now proposes to formally adopt the emergency regulations, with the changes found in the text of the proposed regulation. According to DMHC in its initial statement of reasons, this proposed regulation is necessary as it “sets forth and clarifies the requirements of Health and Safety Code section 1363.04 and implements the goals of SB 1008 by providing a comprehensive and easily understandable SDBC for consumers.”

According to the notice, DMHC anticipates that the proposed formal adoption of the regulation will provide significant benefits for consumers pertaining to dental health care services, and that the formal adoption will provide clarification to medical providers by simplifying the task of completing the SDBC by identifying who must provide the SDBC and to whom they must provide it to. This would ensure that the public “ha[s] access to useful and comparable information regarding the extent of coverage and costs of dental services offered by various health plans and dental plans,” and allow consumers to better compare different dental plans.

Though the proposed regulation remains largely the same as the emergency regulation, minor changes have been made. It is now proposed that the regulations shall apply to “health care service plans or specialized health care service plans, issuing, selling, renewing, or offering a contract on or after January 1, 2022, that covers the provision of dental services.” Changes made include a new requirement that a paper copy of the SDBC be made available free of charge, and that providers must inform the group, rather than an enrollee, how to contact the plan for a paper copy or with any questions. Other subdivisions were amended for consistency with references to federal and state law throughout the text of the proposed regulation. Finally, health care and specialized health care service plans must affirm their compliance with the proposed regulation by April 1, 2022.

The written public comment period ended on September 8, 2021. At the time of this writing, no further action has been taken on the rulemaking package.

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