NADP Advocacy Improves NCOIL Model Act, Removes Medical Loss Ratio Provision

The National Council of Insurance Legislators (NCOIL) Health Insurance & Long-Term Care Issues Committee convened on Dec. 10 and voted in favor of the Transparency in Dental Benefits Contracting Model Act (“Model Act”), which was adopted by the NCOIL Executive Committee on Dec. 12.

The adopted version of the Model Act reflects substantial changes from an earlier version that was introduced by the American Dental Association (ADA) as the “Patient Dental Care Bill of Rights” in December 2019. At the time of introduction, NADP stood in opposition to the Model Act for its failure to accomplish the goals of improving the welfare of dental consumers. In the spring of 2020, NADP along with industry partners (America’s Health Insurance Plans (AHIP) and American Council of Life Insurers (ACLI), submitted a letter of opposition, offering up an alternative proposal that focused solely on network leasing. In person testimony on this issue from NADP Executive Director, Eme Augustini, encouraged the Committee to strike several provisions that were unrelated to leasing including “medical loss ratios, [which] have scarcely been considered by any states at all, and are enormously controversial.”

The in-person testimony at NCOIL meetings and grassroots outreach from member companies, stressing the impact of various provisions on dental benefits consumers, prompted a more thorough review of the draft Model by Committee members. While the NADP alternative proposal addressing leasing only was not adopted, the Model Act’s overpayment recovery and medical loss ratios provisions were removed from the Act, and NADP and its partners reached a successful compromise with the ADA making numerous favorable amendments to the remaining sections on network leasing, prior authorizations, and virtual credit cards.

In written and oral comments delivered to the bill sponsors on Dec. 10, NADP voiced its support for keeping providers well-informed and giving dentists choices with regard to their participation in a carrier’s leasable network, stating that Association was pleased that Model Act “recognizes that network leasing is an important practice that creates value for employers, providers, and consumers by expanding carriers’ networks.” NADP raised the industry’s remaining concerns that requirements in the leasing section related to the provider renewal process were administratively burdensome and called on the sponsors to strengthen wording in the Model Act distinguishing prior authorizations from pre-treatment estimates, which are voluntary and non-binding. 

NADP will continue to work with state legislatures in an effort to ensure that any bills introduced on the subject of network leasing or prior authorization contain provisions that are favorable to the dental benefits industry.