California Legislature (healthcare bills) · October 1, 2025 · Primary source
CA SB 386: Dental providers: fee-based payments.
Summary
California SB 386, chaptered as Chapter 219, Statutes of 2025, amends the Knox-Keene Health Care Service Plan Act to regulate payment methods used by health care service plans, health insurers, and their contracted vendors when paying dental providers. Effective April 1, 2026, plans and insurers must default to a non-fee-based payment method and obtain affirmative consent before enrolling a dental provider in a fee-based payment method. The consent decision applies to the provider's entire practice and all contracted products or services, and providers may opt out at any time.
What this may mean
Health care service plans, health insurers, and contracted vendors that currently use fee-based payment methods as a default for dental providers must restructure their payment processes by April 1, 2026, applying to contracts issued, amended, or renewed on or after that date. A willful violation of the Knox-Keene Act, including these new requirements, constitutes a crime under California law, creating potential criminal exposure for noncompliant plans. The opt-in/opt-out consent requirement applies practice-wide and across all contracted products, meaning a single consent election governs all of the dental provider's billing relationships with that plan or vendor.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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