Jan. 2020


GRW Scrutinizing Hot State Issues

In addition to tracking key legislative trends in 2020, the Government Relations WorkGroup (GRW) also addresses active state legislation and regulations impacting the dental benefits industry. The GRW is also engaged with the National Conference of Insurance Legislators (NCOIL) regarding development of a model act on network leasing proposed by the American Dental Association.

As many state legislatures are beginning their sessions, GRW members are taking a leading role in advocating for the industry and using NADP resources to support their efforts. They have identified the following bills as current priorities.

Priority Bills

Arizona SB 1138 contains provisions regarding dental insurance, websites, overpayment and pre-determinations. Highlights include:

  1. Requires insurers to create a website to include information about each type of enrollee contract allowing enrollees and providers to determine the covered services under each and payment/reimbursement amounts for each.
  2. Prohibits an insurer from deducting the amount of an overpayment of a claim from a payment of another claim unless both claims were for covered services provided to the same subscriber by the same dentist.
  3. An insurer that provides a written predetermination for a covered service including a specific payment amount may not reimburse that dentist for an amount less than the one included in the predetermination.

Maine LD 1975 (SP 677) includes provisions about pediatric dental waiting periods. The bill would prohibit a carrier from imposing a waiting period for any dental or oral health service or treatment, except for orthodontic treatment, for an enrollee under 19 years of age.

Maryland SB 174 is a consensus bill by Maryland Dental Association and the Association of Dental Support Organizations regarding ownership and operation of dental practices. The bill would require a dental practice to be owned by a licensed dentist or a dental professional corporation and establish only a certain individual licensed by the State Board of Dental Examiners may take certain actions.

Nebraska SB 954 is a network leasing bill. The bill proposes that at the time a contract is entered into and renewed or amended, the insurer is required to allow a provider to choose not to participate in third party access. The third-party access provision of contract must be clearly identified in 12-point underlined text. GRW members are currently reviewing this bill and considering alternative language that could be proposed to the bill sponsor.

New York 2811 is a non-covered services (NCS) bill, which would prevent an insurance or managed care company from including in their contracts any provisions that require a dentist to provide services to a covered person at a fee set by or at a fee subject to the approval of the insurer or managed care entity unless such services are covered under the person’s dental plan.

The definition of covered services is: “dental care services for which a reimbursement is available under an enrollee’s plan contract, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation.”

Vermont 734 is also an NCS bill that proposes a different definition of “noncovered services.” The bill proposes the definition of NCS as dental care service that is not reimbursable under a covered individual’s dental insurance plan even absent a contractual limitation such as a deductible, co-payment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, or alternative benefit payment. The bill would also prohibit restricting payments to provider in a way where the only method of payment is credit card. GRW members are marking up the bill language, and NADP is supplying resources and support in this process.

West Virginia HB 4171 /SB 279: These bills would require plans to honor Assignment of Benefits (AOBs) made in writing by covered persons.

NCOIL Leasing Model Update

NADP is working with the Association of Health Insurance Plans (AHIP) and the American Council of Life Insurers (ACLI) regarding alternative language for the network leasing model under development by NCOIL.

State Update: Nevada Network Denial Letter Available

NADP informed GRW members that the Nevada Department of Insurance has published the form letter carriers must use to notify providers of the denial of their application to be included in the carrier’s network. This form letter was created to meet the requirements of Nevada SB 234 passed last year.

For more information about state issues, contact Associate Director of Government Relations Artur Bagyants.


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