August 2015


State Developments in OK, NY, OR and more…

The Government Relations Workgroup (GRW) and Exchange Policy Workgroup (EPW) continue to meet and discuss state legislative session and Exchange developments. Currently the groups are closely monitoring developments on the Oregon Exchange standard plan designs, New York network adequacy rules and the interpretation of a NCS measure in Oklahoma.

OK AG Reverses NCS Interpretation

Plans Can Limit Fees for Services Not Fully Reimbursed under Subscriber Agreement

According to a June 25, 2015 opinion, the Oklahoma Attorney General has reexamined the state’s non-covered services (NCS) statute and found the definition of “covered services” includes any service that is capable of being reimbursed, including those that are limited by cost-sharing provisions. An example of a service where a contract can limit fees would be a third teeth cleaning, which is usually past a frequency limitation.

This reverses a previous opinion from December 2013 where the Attorney General determined that “covered services” did not include services that are not reimbursable due to contractual limitations.

The June 2015 opinion seemed to be sparked by a request for review from Oklahoma Insurance Commissioner John D. Doak. The change in interpretation was also based in part on the decision in Iowa Dental Association v. Iowa Insurance Division, which focused on the differences between the terms reimbursed and reimbursable.


NADP to Join LICONY Effort re: Challenging NY Network Requirements

NADP will participate on a call of the LICONY Dental Insurance Subcommittee this month to discuss a potential meeting with New York Exchange staff and the Department of Financial Services (DFS) on network adequacy requirements being applied to standalone dental plans offered in the state. Carriers and EPW volunteers have expressed concern with the level of network adequacy required by DFS, particularly in more rural parts of the state.


EPW Drafting Comments re: OR Exchange Standard Plan Designs

The Exchange Policy Workgroup (EPW) is drafting comments to submit this month urging the Oregon Insurance Division (OID) to oppose a recommendation from the Standard Plan Rulemaking Advisory Committee to mandate embedded pediatric dental benefits in standard plan designs offered on the Exchange in Plan Year 2017.

As noted previously in the Health Care Reform Open Forum of Dental Interact (DI), if this recommendation is upheld by OID, Oregon would join Connecticut in requiring medical carriers to embed pediatric dental benefits in standard plan designs. Thus, medical carriers would be required to offer a standard benefit plan with embedded dental in order to participate on the Exchange. Medical carriers could also offer additional non-standard plans, which are allowed to omit the dental benefits. The concern from an SADP perspective is that if QHP issuers are required to embed in at least one plan, they may only offer that one plan or embed in all other Exchange offerings (standard and non) thus limiting consumer choice and the market for standalone products.


OH Rule Hearing Sees No Mention of Dental

At an Ohio Department of Insurance (ODI) hearing this month, there were no questions or comments related to dental benefits and the proposed rule 3901-8-16 on Required Provider Network Disclosures for Consumers. As reported previously in the Government Relations Open Forum of Dental Interact (DI), ODI responded to dental carrier and NADP concerns and revised the definition of “health benefit plan” to eliminate the inclusion of dental plans.



blue dots

Join NADP Today