MA HB 951 with Dental Loss Ratio, NCS Introduced

March 2015

MA HB 951 with Dental Loss Ratio, NCS Introduced

Massachusetts House Bill 951 has been introduced and referred to the Committee on Financial Services, which is chaired in the House by Rep. Michlewitz.

It appears the bill would establish 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 would require dental benefit plans to cover 100 percent of preventive and diagnostic services for those individuals aged 18 and older. For individuals under 18, the bill would require dental plans to cover 100 percent of preventive and diagnostic services and basic restorative services. Annual maximums less than $1,000 would be prohibited. Also, any unused annual maximum would be required to be carried over the calendar year. Waiting limits on preventive and diagnostic services would be prohibited. The bill also includes a brief non-covered services (NCS) provision without any definition for covered service. Also, the bill gives the Commissioner the authority to disapprove any reimbursement fee methodologies that do not increase reimbursements by at least the most recent calendar year’s percentage increase in the New England dental CPI. There are also provisions requiring rate review for dental plans.

Background

The Massachusetts state legislature approved the idea for a special commission to study dental insurance after a non-covered services (NCS) bill had been vetoed by the Governor. In 2013-14, the Commission studied carrier contracts, reimbursement, dental fees and other aspects of dental coverage. The Commission’s report to the legislature included recommendations on mandated benefits, quality standards, reimbursement for specialty dentists, loss ratios and NCS.

MA HB 951 appears to be the state dental society’s response to the issues addressed by the Commission and includes elements from prior year bills sponsored by the dental association. Interested stakeholders and Commission participants are discussing the bill, and it’s not clear how much it has been actively lobbied by the sponsors. The dental association will have a day on the Hill on or about April 15.

The NADP Government Relations Workgroup (GRW) will begin to develop a letter in opposition for the Committee and circulate talking points and drafts with volunteers for review.