LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
200 W. Washington St., Suite 301
Indianapolis, IN 46204
(317) 233-0696
iga.in.gov
FISCAL IMPACT STATEMENT
LS 6590 NOTE PREPARED: Jan 12, 2022
BILL NUMBER: SB 136 BILL AMENDED: Jan 12, 2022
SUBJECT: Dental Plans and Access to Dental Networks.
FIRST AUTHOR: Sen. Zay BILL STATUS: CR Adopted - 1
st
House
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
FEDERAL
Summary of Legislation: This bill has the following provisions:
It prohibits a dental plan (an insurance policy, a health maintenance organization contract, or a preferred
provider plan) from directly or indirectly requiring a dental provider to provide a dental service to a covered
individual at a fee amount that is: (1) set by the dental plan; or (2) subject to the approval of the dental plan;
unless the dental service is a covered service under the dental plan.
It provides that a dental plan violates this prohibition by requiring a dental provider to provide a dental
service to a covered individual at a fee amount set by the dental plan or subject to the dental plan's approval
even if the dental service is a covered service if the coverage of the dental service is merely nominal or de
minimis coverage.
It prohibits a third party administrator or another person from arranging for a dental provider to provide
dental services for a dental plan that sets the amount of the fee for any dental services unless the dental
services are covered services under the dental plan.
It also provides that a contracting entity (a dental carrier, a third party administrator, or another person that
enters into a provider network contract with providers of dental services) may not grant a third party access
to the provider network contract or to dental services or contractual discounts provided pursuant to the
provider network contract unless certain conditions are satisfied.
It provides that when a provider network contract is entered into or renewed, or when there are material
modifications to a provider network contract, any dental service provider that is a party to the provider
SB 136 1 network contract must be allowed to choose not to participate in the third party access.
It prohibits a contracting entity from: (1) altering the rights or status under a provider network contract of
a provider that chooses not to participate in third party access; or (2) rejecting a provider as a party to a
provider network contract because the provider chose not to participate in third party access.
It authorizes the Insurance Commissioner to issue a cease and desist order against a person that violates any
of these prohibitions and, if the person violates the cease and desist order, to impose a civil penalty upon the
person and suspend or revoke the person's certificate of authority.
Effective Date: July 1, 2022.
Explanation of State Expenditures: The Department of Insurance (DOI) may have additional workload to
issue cease and desist orders and to publish notice and hold hearings for violation of the cease and desist
order. Assuming near customary agency staffing and resource levels, the added work should be able to be
implemented with no additional appropriations. [The DOI is funded through a dedicated agency fund.]
Explanation of State Revenues: Additional fees may be collected at the discretion of the judge and
depending upon the particular type of case. The bill allows the DOI impose a civil penalty of up to $10,000
for each day of a violation, which would be deposited in the state General Fund. Suspending or revoking a
violator’s certificate of authority would reduce the fee revenue to that is deposited in the agency’s dedicated
fund.
For disputes concerning these contractual requirements, parties to the contract may file civil actions. A civil
costs fee of $100 would be assessed when a civil case is filed. If additional civil actions occur and court fees
are collected, revenue to the state General Fund may increase. A portion of the fee revenue is deposited into
the State User Fee Fund.
Explanation of Local Expenditures:
Explanation of Local Revenues: If additional civil actions occur and court fees are collected, local
governments would receive additional revenue from both a portion of the civil costs fee and other fees that
would be collected.
State Agencies Affected: DOI.
Local Agencies Affected: Trial courts, city and town courts.
Information Sources:
Fiscal Analyst: Karen Rossen, 317-234-2106.
SB 136 2