News
Last month, the Iowa Insurance Division (IID) reported on Dental External Review
to the Governor and state legislature as required by a law passed in
2014. The report includes background and legislative history on external
review for dental in the state, summary of stakeholder comments and IID
findings. The IID concludes that no future amendments to statute
include additional dental external review processes beyond medical
necessity.
Background
An Iowa
appropriations bill (HB 2463) funding state Health and Human Services
was amended last spring to include dental plans in the application of
external review requirements, a process intended for the appeal of a
denial of coverage based on medical necessity. The bill also required
IID to engage stakeholders to review the differences in the bases used
for external review of adverse determinations as applied to health care
services relative to dental care services with the aim of potentially
expanding dental external review beyond just medical necessity.
The Division
held meetings with stakeholders and accepted comment last fall and
winter. Stakeholders commenting included the state Dental Association,
Delta Dental, the Federation of Iowa Insurers, Delta Dental Plans
Association (DDPA) and state Senator Matt McCoy. NADP submitted comments about the various pitfalls in adopting external review of adverse determinations for dental plans.
