CA SB242

Health care service plans and health insurers must reimburse contracting health care providers for business expenses to prevent the spread of respiratory-transmitted infectious diseases during public health emergencies declared on or after January 1, 2022.

Reimbursable "business expenses" include personal protective equipment, additional supplies, materials, and clinical staff time beyond those typically included in office visits, limited to one encounter per day per enrollee or insured for the duration of the emergency.

Applies to physicians and surgeons, dentists, and doctors of podiatric medicine who own or operate practices and are contracted with the plan or insurer; excludes Medi-Cal managed care plans.

Does not apply to the COVID-19 pandemic emergency declared on March 4, 2020, or require reimbursement for changes delegating financial risk for testing without new contract negotiations.

The Department of Managed Health Care and Department of Insurance must ensure timely reimbursement and may adopt guidance to implement the requirement.