Bill Text: MO HB2172 | 2014 | Regular Session | Introduced
Bill Title: Establishes requirements for any entitity providing dental services
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2014-04-15 - HCS Voted Do Pass (H) [HB2172 Detail]
Download: Missouri-2014-HB2172-Introduced.html
SECOND REGULAR SESSION
97TH GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE FRANKLIN.
6426H.01I D. ADAM CRUMBLISS, Chief Clerk
AN ACT
To amend chapter 376, RSMo, by adding thereto one new section relating to insurance for dental services.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 376, RSMo, is amended by adding thereto one new section, to be known as section 376.1060, to read as follows:
376.1060. 1. As used in this section, the following terms shall mean:
(1) "Contracting entity", any person or entity that is engaged in the act of contracting with providers for the delivery of dental services or the selling or assigning of dental network plans to other health care entities;
(2) "Identify", providing in writing, by email, or otherwise the name, address, telephone number, and website of the party to be identified;
(3) "Network plan", health insurance coverage offered by a health insurance issuer under which the financing and delivery of dental services are provided in whole or in part through a defined set of participating providers under contract with the health insurance issuer;
(4) "Participating provider", a provider who, under a contract with a contracting entity, has agreed to provide dental services with an expectation of receiving payment other than coinsurance, co-payments, or deductibles directly or indirectly from the contracting entity;
(5) "Provider", any person licensed under section 332.071.
2. A contracting entity shall not sell, assign, or otherwise grant access to the dental services of a participating provider under a health care contract unless expressly authorized by the health care contract. The health care contract shall specifically provide that one purpose of the contract is the selling, assigning, or giving the contracting entity rights to the services of the participating provider, including network plans.
3. Upon entering a contract with a participating provider and upon request by a participating provider, a contracting entity shall properly identify any third party that has been granted access to the dental services of the participating provider.
4. Any contracts entered into or renewed on or after the effective date of this section shall require that at any time a contracting entity sells, assigns, or otherwise grants access to the dental services of a participating provider, it shall allow the participating provider the option to refuse to continue to provide services to third party entities which have purchased, been assigned, or otherwise been granted access to the dental services of a participating provider by the contracting entity.
5. A contracting entity that sells, assigns, or otherwise grants access to the dental services of a participating provider shall maintain an internet website or a toll-free telephone number through which the participating provider may obtain a listing, updated at least every ninety days, of the third parties that have been granted access to the participating provider's dental services.
6. Any third party entity within thirty days of purchasing, being assigned, or otherwise accessing the dental services of a participating provider shall provide to such participating provider a listing of the one hundred most frequently reimbursed American Dental Association Current Dental Terminology codes by such third party entity and the amount by which such third party entity reimburses a participating provider.
7. A contracting entity that sells, assigns, or otherwise grants access to a participating provider's dental services shall ensure that an explanation of benefits or remittance advice furnished to the participating provider that delivers dental services under the health care contract identifies the contractual source of any applicable discount.
8. All third parties that have contracted with a contracting entity to purchase, be assigned, or otherwise be granted access to the participating provider's discounted rate shall comply with the participating provider's contract including all requirements to encourage access to the participating provider and pay the participating provider pursuant to the rates of payment and methodology set forth in that contract unless otherwise agreed to by a participating provider.
9. A contracting entity is deemed in compliance with this section when the insured's identification card provides information which identifies the insurance carrier to be used to reimburse the participating provider for the covered dental services.
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