In July NADP published the 2021 State Legislative Wrap-up after most state legislatures adjourned. In addition, NADP continued to represent our members on various key issues over the summer and fall.
NADP Opposes Ohio NCS Bill
In November, NADP opposed Ohio HB 344, a non-covered service (NCS) bill, which was considered at an opponent hearing on Nov. 17. NADP submitted written testimony in opposition of this bill because, while it would not increase costs for insurers, it would increase out-of-pocket dental care costs for Buckeyes that have dental benefits.
State APCD Report Released
In the fall, NADP informed members about the State All Payer Claims Databases (APCD) Advisory Committee Report, released by the State All Payer Claims Databases Advisory Committee (SAPCDAC). The SAPCDAC was formed by the “No Surprises Act” (from 2020 U.S. HR 133) and charged with advising the Secretary of Labor regarding the standardized reporting format for the voluntary reporting by group health plans to APCDs.
Reporting will include medical claims, pharmacy claims, dental claims, and eligibility and provider files collected from private and public payers. The SAPCDAC recommended that Department of Labor should use the content of the APCD-Common Data Layout (CDL) as the basis for the standard reporting format for submitting self-funded plan data to APCDs. Because of the grant funding also provided by the No Surprises Act and interest in reducing health care costs, NADP members will continue to see State APCD legislation that could be heavily influenced by this report.
Massachusetts Bills and Ballot Question on MLR
On July 27, the Massachusetts Joint Committee on Financial Services considered a number of bills around dental insurance, including bills on assignment of benefits, medical loss ratio, so-called “dental patient bill of rights,” and direct dental care agreements. NADP, along with industry stakeholders, submitted testimony in strong opposition to these bills.
Also happening in Massachusetts is an effort to put dental plan medical loss ratio on the ballot. It includes loss ratio requirement, reporting and financial reporting, plus other elements, such as an Affordable Care Act-type refund procedure, and Attorney General involvement in hearings and otherwise. NADP, along with industry partners, are actively engaging in the process and will keep our members updated.
New Oregon Law on Patient Data Collection
On July 19, the Oregon Governor signed H. 3159, which requires health care providers and insurers, including standalone dental plans (SADPs), to collect from a patient, client, or member, data on race, ethnicity, preferred spoken and written languages, disability status, sexual orientation, and gender identity. It also imposes civil monetary penalties. House Bill 3159 becomes effective on September 25, 2021, but the section on collecting data becomes operational January 1, 2022. NADP and its industry partners will be exploring ways in which it can influence any rulemaking on this bill or future legislation on this issue.
2021 State Legislation Wrap Up
The majority of states have adjourned their legislative sessions for the year and NADP has prepared a summary on key bills from 2021. The Government Relations Workgroup (GRW) met twice monthly during the first five months of the year to analyze nearly 180 bills, the most significant of which are mapped and described below.
There were multiple bills that would attempt to recoup money from insurers to providers for money lost during the COVID-19 and future pandemics. NADP worked to remove dental plans from these bills.
California SB 242 (passed) – Requires insurers to reimburse dentists for medically necessary operations during the COVID-19. The California Association of Dental Plans (CADP) successfully influenced this bill to amend it to future pandemics involving respiratory diseases and narrowed the scope to personal protective equipment (PPE). CADP and NADP still opposed.
California A. 454 (held on suspense) – Would have required insurers to provide grants and cash payments for expenses. CADP worked to influence this bill and it is held on suspense for now.
New Jersey A. 4538 (pending) —Requires dental insurers to provide credits to policyholders for reductions and delays in utilization during coronavirus disease 2019 pandemic. NADP was able to secure positive changes to the bill and dropped opposition. The bill has been sent to the governor for signature.
Rhode Island SB 709 (held for study) — Prohibits certain deductions, requires coverage where there is a pre-existing conditions or any earlier treatments, mandates pandemic rollover benefits, and an annual report on dental coverage. NADP was opposed and the bill was held for study.
Washington SB 5169 (passed) – Insurers are required to reimburse providers for PPE during the state of emergency related to COVID-19. After conversations between NADP and Washington stakeholders, stand-alone dental plans were not included.
Numerous bills addressed provider billing issues, such as overpayments, non-covered services, and virtual credit cards. These issues have been a focus at recent National Council of Insurance Legislators (NCOIL) meetings where dental models have been developed.
Louisiana SB 82 (passed) — Adds dental insurance benefits to the Health Insurance Issuer External Review Act. An amendment set a $250 claim minimum threshold to go to external review. NADP opposed this legislation.
Missouri SB 401 (dead) — This downcoding bill appears to inhibit dental plans’ ability to apply alternate treatment language, deny treatment that is not medically necessary, and apply usual and customary charges. The bill did not have any activity post introduction.
Nevada SB 269 (passed) — Imposes requirements governing the recovery of overpayments under a plan that provides dental coverage and prohibits a dental insurer or the administrator of a plan that provides dental coverage from denying a claim for which prior authorization has been granted except in certain circumstances. NADP worked with sponsors to improve this bill and was neutral.
New Jersey A. 4820 (pending) — Prohibits certain provisions in agreements between insurance carriers and participating dentists and would permit dentists to balance bill patients for expenses above and beyond that which is paid for by their dental plan. This bill is still being considered and NADP is opposed.
North Dakota HB 1154 (passed) — This bill relates to prior authorization of dental services, dental networks, and payment of dental claims. NADP was successful in getting a MLR provision removed.
Texas HB 1934 (dead) —This bill relates to overpayment recovery and third-party access to provider networks for certain insurance policies and benefit plans that provide dental benefits (network leasing). NADP worked with sponsors of the bill to improve the language; however, the bill died upon adjournment of the session.
Network leasing was a perennial issue this year as a result of the most recent dental related model law coming from NCOIL. NADP was successful in getting changes to most bills to better conform to the model law.
Connecticut HB 6589 (passed) — This bill concerns third-party access to participating dental provider contracts, otherwise known as network leasing. NADP was able to secure some changes but opposed this legislation.
Idaho SB 1124 (passed) —This bill is regarding contracts with providers of dental services and virtual credit cards. NADP worked with stakeholders to improve opt-out language in the network leasing section.
Kansas HB 2386 (dead) — Addresses network leasing, prior authorizations, and virtual credit cards. It did not receive any activity this session.
Louisiana HB 387 (passed) — NADP was able to secure positive changes on notifications and remained neutral.
South Dakota SB 1073 (passed) — Authorize dentists to void certain contract terms with insurers. NADP, along with industry partners, worked with the state dental association to improve the bill.
Utah HB 359 (passed) — Regulates dental claims and dental leasing contracts. NADP was able to secure a change on opt-out language.
Telehealth expanded rapidly during the COVID-19 pandemic and legislators across the country hoped to cement the flexibilities granted by the states into law. As a result, many legislatures defined teledentistry.
Colorado SB 139 (passed) — Requires each dental plan issued, amended, or renewed in this state to cover services offered to a covered person through telehealth.
New Mexico SB 200 (passed) — Redefines teledentistry to mean the use of electronic information, imaging and communication technologies, including interactive audio, video and data communications as well as store-and-forward technologies, to provide and support health care delivery, diagnosis, consultation, treatment, transfer medical data and education.
Oregon HB 2508 (passed) — Requires dental plans pay the same reimbursement regardless of whether a service is provided in person or using telemedicine. Furthermore, despite requirements for “audio only” coverage, the bill would apply to stand-alone dental plans.
Texas HB 2056 (passed) — Concerns the practice of dentistry and the provision of teledentistry dental services. Among other provisions, the bill requires a health benefit plan to provide coverage for teledentistry dental service provided by a contracted provider on the same basis as if the individual was seen on an in-person basis.
Dental Loss Ratio/Reporting
Dentist trade associations have been advocating for years to include a dental loss ratio (DLR) into state laws and unsuccessfully tried to include it in NCOIL’s most recent dental model legislation. NADP was successful in preventing several of these bills from passing this year and will continue to advocate against attempts to require a DLR.
Arizona HB 2869 (passed without DLR) — There was an amendment that ultimately was not considered to this budget bill that would have given interested parties a chance to review the annual medical loss ratios of dental insurance companies by requiring a filing with Arizona Health Care Cost Containment System (AHCCCS), which would then publish the reports. However, there will be language that requires Arizona Department of Insurance and Financial Institutions (DIFI) to do a report on medical loss ratios based on existing dental plan filings. Dental plans will not be required to report anything new, but DIFI will be pulling data from the current rate filings.
Maine LD 1266 (carried over) — This bill would have established a minimum medical loss ratio of 80% for dental plans and require rebates to be provided in any year in which a dental plan’s medical loss ratio is less than the minimum. NADP, along with industry partners, opposed, and the bill was ultimately tabled.
Montana HB 321 (dead) — This bill would impose limitations on down coding by dental plans, prohibit the use of virtual credit cards, and require insurance companies publish loss ratios on company websites. NADP proposed amendments and submitted testimony. The bill ended up dead.
Nevada SB 391 (dead) — This bill originally included a reporting Dental Loss Ratio but was dropped and primarily turned into a teledentistry bill that was ultimately vetoed by the governor.
Ohio HB 344 (pending) – This bill defines noncovered services. Ohio does not currently have an NCS law.
Rhode Island HB 5160 (held for study) — This bill attempted to redefine “covered services” for dental, deviate from the NCOIL definition, and remove the application of some contractual limitations. NADP, along with industry partners, sent a letter in opposition, and ultimately the bill was held for further study.
Vermont HB 294 (dead) — Addresses noncovered services and virtual cards. It did not have any activity this session.
Illinois SB 493 (passed) — Requires all dental plan carriers and dental care providers to exchange claims and eligibility information electronically using the standard electronic data interchange transactions for claims submissions, payments, and verification of benefits required under Health Insurance Portability and Accountability Act (HIPAA).
Texas SB 2124 (passed) – Enables dental plans operating within the state to transition from paper-based to electronic delivery of certain customer communications. NADP supported this legislation.