GR Workgroup Updates as State Legislatures Adjourn

June 2016

GR Workgroup Updates as State Legislatures Adjourn

As most states have adjourned their legislative sessions, the Government Relations Workgroup (GRW) can share updates on some of the more noteworthy 2016 priority bills. The group met twice monthly over five months to discuss 300+ priority bills offered in state legislatures, which are heat-mapped below.

The following are a few of the legislative proposals the GRW discussed.

Leasing Dental Networks

• GA SB 158—enacted: This bill requires rental preferred provider networks or contracting entities to register with the Commissioner. Contracting entities would be required to maintain a website or other mechanism through which a provider can obtain a listing (updated every 30 days) of the third-parties to which the entity has leased the network applicable to the provider. Some provisions that would have required agreement before contract changes, for example, have been removed. Also, the definition of health insurer no longer includes dental specifically; however, this does not mean dental plans may not be impacted and carriers and contracting entities should review the bill for applicability.
• IL SB 2355—pending: The original bill text included several requirements for the leasing of dental networks including a provider opt-out provision. The bill as amended and submitted to the Governor requires networks to notify providers of leasing the network 30 days after leasing the contracted provider.
• OK SB 1377—enacted: This bill establishes requirements for any entity engaged in the contracting with providers of dental services or the leasing of dental plans to other dental care entities. Entities must (a) specify in contracts that one purpose of the contract is the selling, assigning or giving the contracting entity rights to the services of the participating provider, including network plans, (b) upon entering a contract with a provider and upon the provider’s request, properly identify any third party that has been granted access to the dental services of the provider, (c) maintain a website or toll-free number where a provider can obtain information which IDs the insurance carrier to be used to reimburse the provider for covered dental services and (d) ensure that an explanation of benefits or remittance advice identifies the contractual source of any applicable discount.

Market Reforms

• IL SB 2266—pending: Similar to what Washington state passed with HB 1002 in 2015, this bill would require issuers to file an annual dental medical loss ratio report. The data would be made public. It is unlikely this bill will progress in the 2016 session.
• MA HB 951—died: This bill would have established a dental loss ratio of 90 percent through December 19, 2016, then raising to 95 percent after January 2017. (The ACA medical loss ratio provision is 85 percent for large groups) Additional sections address non-covered services, annual maximums and waiting limits. All Massachusetts legislation gets a hearing and there was strong opposition in House and Senate Committee meetings. While the 2016 legislation did not move, it is likely that providers will push for similar measures in the future.

Provider Contracts

• AZ HB 2306—enacted: This bill requires all contracts to provide coverage for services provided regardless of the familial relationship of the provider to the subscriber if the service would have been provided. The plan can limit coverage to a network. This would apply to entities regulated under Title 20, chapter 4, article 3 of ARS, which appears to include dental service corporations.
• KY SB 18—enacted: This bill includes several new requirements for notifying providers of material changes to contracts. Section 1 requirements apply to “limited health service benefit plans” (defined at KRS 304.17C) via Section 3. In brief, new requirements include: Prior to revising an existing agreement with a provider, insurer must: (i) provide notice of proposed material changes in an orange-colored envelope at least 90 days in advance, (ii) provide notice of the opportunity for a meeting using any mode of telecommunications to which all users have access; and (iii) provide notice that provider can accept or reject proposed change. Provider must “opt out” or object within 30 days or change will take effect. If change relates to provider’s inclusion in a new product or new network requirement, the notice must be sent by certified mail and insurer must obtain express written agreement from provider before the change can take effect. Insurers must provide notice to provider of right to an updated contract form with material changes included if there have been at least 3 material changes in a 12-month period. Insurers must also adopt written processes regarding the above.

Mid-Level Providers

• VT SB 20—enacted: This bill establishes the dental practitioner scope of practice. A collaborative agreement with dentists would include practice settings where services may be provided and the populations served. The new dental therapists would provide services that include prevention, evaluation, and assessment; education; palliative therapy; and restoration under the general supervision of a dentist within the parameters of a written collaborative agreement.

Network Adequacy, Access and Provider Directories

• CA SB 1135—pending: This bill would require a health care service plan to provide information to enrollees regarding the standards for timely access to care, including information related to receipt of interpreter services. A previous version of the bill would have required plans to include the Department of Managed Health Care (DMHC) toll-free phone number and web address on ID cards. The Association of California Life & Health Insurance Companies (ACLIC) opposed this section and the DMHC expressed concerns that including their phone number would redirect phone calls that should go to carriers. The bill has since been amended to remove the ID card requirement.
• CT SB 433—enacted: This bill requires health carriers to establish and maintain adequate provider networks to assure that all covered benefits are accessible to covered individuals without unreasonable travel or delay. The bill applies to “all health carriers that deliver, issue for delivery a network plan in CT” – “network plan” means a health benefit plan, which at 38a-591a21(B)(ix) does not include limited scope dental.
• GA SB 302—enacted: This bill establishes standards for accurate provider directories, based on part on the National Association of Insurance Commissioners (NAIC) Model. Instances where the bill deviates from the NAIC Model include: (a) a requirement that issuers notify any provider who has not submitted claims in the past 12 months. If an issuer does not receive a response within 30 days that the information regarding the provider is current and accurate (or any updates), then the issuer must remove the provider from the network. (b) a requirement that issuers include in both online and print directories specific ways that enrollees or the public may report inaccurate information. Issuers must investigate the report and no later than 30 days following receipt of the information, verify the accuracy or update the information. (c) an annual audit of a reasonable sample size of provider directories for accuracy. The Georgia Office of Insurance is having informal discussions prior to releasing regulations.
• IL HB 6562—pending: This is a network adequacy bill with prescribed access parameters including: (1) large: 30 minutes or 15 miles, (2) metro: 45 minutes or 30 miles, (3) micro: 80 minutes or 60 miles, (4) rural: 90 minutes or 75 miles. The definitions of “health care network plan” or “insurer” do not include dental. The bill is unlikely to move this year; however, state trades and issuers will continue discussions as it is likely a measure of this kind will be re-introduced next year.
• MD HB 1318—enacted: This bill establishes network adequacy requirements with instructions that the Commissioner develop regulations for dental by December 2017. Future regulations must ensure that enrollees have access to providers without unreasonable delay, access to essential community providers and carrier monitoring of access. NADP is participating in monthly public discussions with the Department.

Exchanges

• CO SB 2—died: This bill would have required voter approval on the November ballot whether the state-based Exchange, known as Connect for Health Colorado, can continue charging a fee to insurers who sell policies on the exchange in order to generate funding. In May, a state House of Representatives panel postponed the bill indefinitely. As background, the Exchange Board is allowed to assess special fees against insurers in an amount necessary to provide funding for the Exchange. The fees for dental cannot exceed eighteen cents per number of lives insured per month and would apply to dental and health insurers that are subject to insurance regulation in the state (on and off the Exchange). The Exchange has not yet included dental in the assessment.
• WA HB 2768—enacted: This bill allows the state-based Exchange to levy an assessment on standalone family dental plans to help fund operations and the development of technology to begin offering adult and family benefits on the Marketplace. This bill represents the only methodology to fund the expansion of dental offerings that the Insurance Commissioner can support.

Non-Covered Services

• OH HB 95—pending: The bill was most recently heard in the Senate Insurance Committee in April. The Chairman of the Committee has indicated that he does not have any plans to schedule another hearing and a vote on the bill now that the opponent testimony is on the record, and the Senate President remains opposed to the legislation. The Ohio General Assembly will be on summer recess beginning in June. They may return to Session briefly in the fall, but most legislative activity will wait until the lame duck Session begins after November’s election.
• VA HB 16—enacted: This bill amends current Non-Covered Services (NCS) law to include a prohibition on nominal reimbursement. The bill does not offer a specific percentage.

NADP members can view all priority bills and notes from the GRW calls on the GR Grid updated regularly on the Advocacy Resources webpage. Members can also receive updates and discuss developments in the Dental Interact (DI) Advocacy Open Forum.