August / September 2020 Edition
NADP 2020 Legislative Wrap Up
Every year the NADP Government Relations Workgroup (GRW) compiles a review of relevant state policy activity for the year. The GRW tracks and analyzes legislation and regulations, and advocates on behalf of the industry on key issues. While 2020 has been an unusual year due to the COVID-19 pandemic, the GRW continued its regular work while also creating resources related to the pandemic.
This “heat map” of state legislation is a geographical representation of the bills listed below, with each color representing the number of relevant bills identified by the GRW in that state in 2020.
State Legislation and Regulations
The GRW meets biweekly to discuss new state legislation and regulations to determine their impact on the industry. NADP staff track all 50 states and identify key issues that are escalated to the GRW for review. Below is a list of topics the GRW has analyzed so far in 2020.
Arizona SB 1138 (pending) – Would require insurers, including dental plans, to: 1) create a website to include information about each type of subscription contract allowing subscribers and providers to determine the covered services under each and reimbursement amounts for each; 2) prohibit insurers from deducting the amount of an overpayment of a claim from a payment of another claim; 3) prohibit insurers that issue a written predetermination for a covered service from reimbursing a dentist for an amount lower than the one included in the predetermination. This bill was originally introduced by the state dental association and has been tabled for the time being so the industry and dentists can hold talks to address the dentists’ concerns.
Colorado SB 215 (enacted) – Creates the Health Insurance Affordability Fee starting in 2021. The fee is 1% of premiums on nonprofit carriers and 2.5% on for-profit carriers. NADP and partners have advocated to exclude dental plans from such fees, and they are not included in this bill.
Georgia HB 888 (enacted)– This bill contains several provisions related to “surprise billing.” Dental plans are not excluded from the bill’s provisions. It would require an insurer that provides any emergency medical services benefits to covered persons to pay for such services regardless of whether the provider or facility furnishing those services is in-network. For purposes of the covered person’s financial responsibilities a carrier must treat the emergency services received by such person from a non-participating provider as if the services were provided by a participating provider.
Georgia SB 482 (enacted)– Would create an all payer claims database (APCD), with dental plans included in the definition of “submitting entity.” The objectives of the APCD are to facilitate data-driven evidence-based improvements in access, quality, and cost of care. The bill also outlines the claims data that submitting entities are required to submit.
Illinois HB 272 (pending) – “Health Insurer Claims Assessment Act. Would impose a 1% tax on the paid claims of carriers, including dental plans. Proceeds from the tax would be used exclusively to fund Medicaid services.
Kansas HB 2307 (dead) – Would add language to the state’s existing non-covered services law stating that “covered service” does not include any service or material covered at a nominal or de minimis rate. NADP and AHIP submitted comments in opposition in 2019; the bill carried over to the 2020 session but did not advance any further before adjournment.
Kansas HB 2633 (dead) – Would require a health benefit plan that provides dental care services to: 1) provide information regarding an insured’s dental coverage and benefit maximum payment schedules available to such insured or a dentist designated by the insured; 2) accept claims submitted from a dentist that are formatted or transmitted in any manner authevelorized by law; 3) provide one or more methods of payment that provide the dentist with 100% of the contracted amt of the payment that do not require the dentist to incur a fee to access the payment. The bill would also require an insurer to create a website to provide benefit information to insureds and dentists.
Louisiana HB 311 (enacted) – Prohibits a dental service contractor from denying coverage for a dental condition existing prior to the date the coverage began. A six-month waiting period can be imposed for coverage of pre-existing conditions.
Louisiana HB 353 (enacted) – Prohibits a dental service contractor from systematically downcoding with intent to deny reimbursement otherwise due to a dentist. A DSC may only change a procedure code submitted by a dentist if: 1) the change is consistent with the DSC’s policies and 2) the DSC has sufficient information to make the change.
Maine LD 1975 (SP 677) (enacted) – Prohibits a carrier from imposing a waiting period for a dental or oral health service or treatment (except orthodontic treatment) for an enrollee under 19 years of age.
Maryland SB 174 (HB939) (enacted) – Defines what it means to “practice dentistry” and allows only an individual licensed by the state to practice dentistry to own a dental practice. Allows dentists to enter into contracts allowing unlicensed persons to engage in certain activities related to the business of operating a dental practice.
Maryland SB 99 (enacted) – Requires health insurers, nonprofit health service plans, and health maintenance organizations to state on enrollee benefit cards either “MIA” or “MDH” depending on whether the entity is subject to regulation by the Insurance Administration or the Department of Health. Sec. 15-130 is applicable to prescription drug cards and Sec. 15-130.1 is applicable to cards issued under a policy meeting the definition of minimum essential coverage.
Maryland AG Statement re: PPE – Informs consumers that some dentists may be violating the state Consumer Protection Act by imposing surcharges for personal protective equipment. Consumers have complained to the Attorney General’s office that they are being charged up-front fees for PPE costs, and the AG has informed the dental community that this practice may violate the state’s prohibition against unfair and deceptive trade practices.
Massachusetts HB 1005 / Massachusetts SB 545 (pending) – Would enact a non-covered services law. Prohibits provider contracts from requiring a dentist to provide services to subscribers at a particular rate unless such services are “covered services.” The definition of covered services is consistent with the NCOIL Model Act. Action on this bill in 2020 is unlikely.
Massachusetts HB 3557 / Massachusetts SB 544 (pending) – Would require written consent by a dentist to allow network leasing arrangements. In the absence of written consent, the dentist’s consent is implied if 90 days pass without the dentist’s refusal. Action on this bill in 2020 is unlikely.
Mississippi SB 2833 (dead) – Would amend existing law on prior authorizations by removing the requirement that the dentist making the adverse determination may not be an employee of the insurer. Also removes predeterminations from the definition of “prior authorization.
Nebraska LB 774 (enacted) – Includes network leasing provisions requiring an insurer to allow a provider to choose not to participate in third party access to the contract at the time a provider contract is entered into or renewed. Also includes transparency provisions and requires a third party accessing a provider contract to comply with all appliable terms of the provider contract’s terms. The bill also prohibits plans from requiring credit card payment as the only acceptable method of payment.
New Hampshire SB 749 (LSR 3127) (enacted) – Would enact a non-covered services law. The definition of covered services is consistent with the NCOIL Model Act.
New Jersey AB 4389 (SB 2676) (enacted) – Imposes a tax on insurers to create a “Health Insurance Affordability Fund.” The tax would be 2.75% of an entity’s net written premiums, and applies to health, dental, and vision plans. The bill was amended to reduce the tax rate to 2.5% and to exclude “dental service corporations” (nonprofits) from the bill, while “dental plan organizations” continue to be included.
New Mexico Bulletin 2020-013 – Identifies deceptive and misleading marketing and advertising practices of excepted benefit products. Companies that issue such products must inform current and prospective purchasers that these products do not provide major medical overage. The bulletin outlines examples that qualify as deceptive.
New York AB 2811 (pending) – Would enact a non-covered services law. The definition of covered services is consistent with the NCOIL Model Act. The New York Legislature passed a similar bill in 2017 but it was vetoed by the Governor.
New York AB 2926 (pending) – Would require a policy that provides for reimbursement for dental restorations to also provide reimbursement towards the payment of dental implants.
New York Circular Letter re: PPE – States that participating providers should not be charging insureds fees for personal protective equipment on top of an insured’s financial responsibility for covered services. Also states that issuers should ensure that participating providers do not charge insureds fees beyond the insureds’ financial responsibility for covered services as outlined in the insureds’ policies. Issuers should instruct participating providers to refund any such fees and resolve any issues regarding increased costs due to COVID-19 directly with participating providers.
Ohio HB 681 (pending) – Would require health benefit plans that provide coverage for dental services to provide reimbursement to dentists for personal protective equipment.
Ohio SB 148 (pending) – Would enact a non-covered services law. The definition of covered services is consistent with the NCOIL Model Act.
Pennsylvania Notice re: PPE – Issues guidance to insurers that encounter providers who engage in “inappropriate billing practices” related to personal protective equipment. Insurers are instructed to examine their provider contracts and address PPE fees with providers in accordance with contract terms. In situations where the provider is not in the carrier’s network the carrier can consider referring the matter to the Attorney General’s office.
Puerto Rico Regulatory Letter re: PPE – Addresses personal protective equipment. Requires insurers to include code D1999 in dental coverage commercial health plans. Further requires insurers to establish a corresponding fee for this code in an amount no less than $35 per visit.
Rhode Island SB 2525 (pending) – Would require telemedicine services to be reimbursed at a rate not lower than services delivered in person; would prohibit cost sharing for covered services provided via telemedicine.
Rhode Island H 7774 (pending) – Would require a contract between a dentist and insurer to allow the participating dentist to choose not to participate in third party access to the contract, prior to granting a third-party access to that contract.
Utah HB 37 (enacted) – Omnibus insurance act that includes provisions on payments. Allows a provider to choose not to receive remittance via a credit card or similar arrangement. Prohibits an insurer from requiring a provider or insured to accept remittance via credit card or similar arrangement.
Vermont HB 734 (pending) – Would enact a non-covered services law. The definition of covered services is consistent with the NCOIL Model Act
Washington HB 1018 (dead) – Would extend the provisions of the ‘Patient Bill of Rights’ to dental-only plans. Would subject dental plans to statutes governing utilization management programs, retrospective denial of services, and comprehensive grievance and appeal procedures.
Washington HB 1552 (enacted) – Clarifies that a carrier must use the OneHealthPort database to accept credentialing applications and may not require a provider to submit credentialing information in any other format. Reduces the time that a carrier has to approve or deny an application from 90 days to 45.
Washington HB 2821 (dead) – Would impose a 2.2% tax on premiums on dental only plans for 2021. The tax rate would change to 1.5% for 2022 and subsequent years. The revenue generated by the tax would be used to create a health insurance affordability account.
Washington HB 2901 (dead) – Would impose a 1% tax on paid claims by a covered entity during the preceding calendar year. The revenue generated by the tax would be used to establish a premium assistance fund.
In response to the COVID-19 pandemic NADP created an open forum to track and analyze related issues and facilitate member discussion. Additionally, NADP created tracking resources to follow topics like insurance grace periods, telemedicine initiatives, filing requirements, special enrollment periods, and state re-opening guidelines. These resources are meant to assist members as they navigate the state and federal policy landscape and respond to the pandemic.
NCOIL MODEL ACT
In December 2019 the American Dental Association introduced a model act at the National Council of Insurance Legislators (NCOIL). The proposed act includes five topic areas: network leasing, minimum loss ratios, prior authorization, virtual credit cards, and overpayment recovery. NADP, along with industry partners, submitted a letter of opposition, and offered an alternative proposal that focuses on network leasing only, and resembles the laws enacted in New Jersey and California in 2019. NADP and partners also provided in-person testimony on this issue at NCOIL’s Spring meeting in March 2020. NCOIL is expected to continue considering the proposed model act into 2021.
The legislation referenced in this document was tracked and analyzed using NADP’s legislative tracking system (LOTS). Learn more about LOTS here. If you have any questions, please contact Associate Director of Government Relations Artur Bagyants.