Indiana 2024 Regular Session

Indiana House Bill HB1351 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2	Introduced Version
3	3	HOUSE BILL No. 1351
4	4	_____
5	5	DIGEST OF INTRODUCED BILL
6	6	Citations Affected: IC 27-7-18; IC 27-8-11-14.
7	7	Synopsis: Dental matters. Provides that if an insured assigns the
8	8	insured's rights to benefits for dental services to the provider of the
9	9	dental services, the insurer shall pay the benefits assigned by the
10	10	insured to the provider of the dental services. Prohibits a third party
11	11	administrator or another person from arranging for a dental provider to
12	12	provide dental services for a dental plan that sets the amount of the fee
13	13	for any dental services unless the dental services are covered services
14	14	under the dental plan. Provides that a contracting entity (a dental
15	15	carrier, a third party administrator, or another person that enters into a
16	16	provider network contract with providers of dental services) may not
17	17	grant a third party access to the provider network contract or to dental
18	18	services or contractual discounts provided pursuant to the provider
19	19	network contract unless certain conditions are satisfied. Provides that
20	20	when a dental provider network contract is entered into, renewed, or
21	21	materially modified, any provider that is a party to the network contract
22	22	must be allowed to choose not to participate in the third party access.
23	23	Prohibits a contracting entity from: (1) altering the rights or status
24	24	under a provider network contract of a dental provider that chooses not
25	25	to participate in third party access; or (2) rejecting a provider as a party
26	26	to a provider network contract because the provider chose not to
27	27	participate in third party access. Authorizes the insurance
28	28	commissioner to issue a cease and desist order against a person that
29	29	violates any of these prohibitions and, if the person violates the cease
30	30	and desist order, to impose a civil penalty upon the person and suspend
31	31	or revoke the person's certificate of authority.
32	32	Effective: July 1, 2024.
33	33	Zent, Snow, Fleming
34	34	January 10, 2024, read first time and referred to Committee on Insurance.
35	35	2024 IN 1351—LS 7008/DI 55 Introduced
36	36	Second Regular Session of the 123rd General Assembly (2024)
37	37	PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
38	38	Constitution) is being amended, the text of the existing provision will appear in this style type,
39	39	additions will appear in this style type, and deletions will appear in this style type.
40	40	Additions: Whenever a new statutory provision is being enacted (or a new constitutional
41	41	provision adopted), the text of the new provision will appear in this style type. Also, the
42	42	word NEW will appear in that style type in the introductory clause of each SECTION that adds
43	43	a new provision to the Indiana Code or the Indiana Constitution.
44	44	Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
45	45	between statutes enacted by the 2023 Regular Session of the General Assembly.
46	46	HOUSE BILL No. 1351
47	47	A BILL FOR AN ACT to amend the Indiana Code concerning
48	48	insurance.
49	49	Be it enacted by the General Assembly of the State of Indiana:
50	50	1 SECTION 1. IC 27-7-18 IS ADDED TO THE INDIANA CODE AS
51	51	2 A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY
52	52	3 1, 2024]:
53	53	4 Chapter 18. Third Party Access to Dental Provider Networks
54	54	5 Sec. 1. As used in this chapter, "contracting entity" means a
55	55	6 dental carrier, a third party administrator, or another person that
56	56	7 enters into a provider network contract with providers for the
57	57	8 delivery of dental services in the ordinary course of business.
58	58	9 Sec. 2. As used in this chapter, "covered individual" means an
59	59	10 individual who is entitled to:
60	60	11 (1) dental services; or
61	61	12 (2) coverage of dental services;
62	62	13 through a provider network contract.
63	63	14 Sec. 3. As used in this chapter, "dental carrier" means any of
64	64	15 the following:
65	65	16 (1) An insurer that issues a policy of accident and sickness
66	66	17 insurance that covers dental services.
67	67	2024 IN 1351—LS 7008/DI 55 2
68	68	1 (2) A health maintenance organization that provides, or
69	69	2 provides coverage for, dental services.
70	70	3 (3) An entity that:
71	71	4 (A) provides dental services; or
72	72	5 (B) arranges for dental services to be provided;
73	73	6 but is not itself a provider.
74	74	7 Sec. 4. (a) As used in this chapter, "dental service" means any
75	75	8 service provided by a dentist within the scope of the dentist's
76	76	9 licensure under IC 25-14.
77	77	10 (b) The term does not include a service delivered by a provider
78	78	11 that is billed as a medical expense.
79	79	12 Sec. 5. As used in this chapter, "health insurer" means:
80	80	13 (1) an insurer that issues policies of accident and sickness
81	81	14 insurance (as defined in IC 27-8-5-1); or
82	82	15 (2) a health maintenance organization (as defined in
83	83	16 IC 27-13-1-19).
84	84	17 Sec. 6. As used in this chapter, "person" means an individual, a
85	85	18 corporation, a limited liability company, a partnership, or any
86	86	19 other legal entity.
87	87	20 Sec. 7. (a) As used in this chapter, "provider" means:
88	88	21 (1) a dentist licensed under IC 25-14; or
89	89	22 (2) a dental office through which one (1) or more dentists
90	90	23 licensed under IC 25-14 provide dental services.
91	91	24 (b) The term does not include a physician organization or
92	92	25 physician hospital organization that leases or rents the network of
93	93	26 the physician organization or physician hospital organization
94	94	27 network to a third party.
95	95	28 Sec. 8. As used in this chapter, "provider network contract"
96	96	29 means a contract between a contracting entity and one (1) or more
97	97	30 providers:
98	98	31 (1) that establishes a network through which the providers:
99	99	32 (A) provide dental services to covered individuals; and
100	100	33 (B) are compensated for providing the dental services; and
101	101	34 (2) that specifies the rights and responsibilities of the
102	102	35 contracting entity and the providers concerning the network.
103	103	36 Sec. 9. (a) As used in this chapter, "third party" means a person
104	104	37 that enters into a contract with a contracting entity or another
105	105	38 third party to gain access to:
106	106	39 (1) a provider network contract;
107	107	40 (2) dental services provided pursuant to a provider network
108	108	41 contract; or
109	109	42 (3) contractual discounts provided pursuant to a provider
110	110	2024 IN 1351—LS 7008/DI 55 3
111	111	1 network contract.
112	112	2 (b) The term does not include an employer or another group or
113	113	3 entity for which the contracting entity provides administrative
114	114	4 services.
115	115	5 Sec. 10. (a) This section applies if a contracting entity seeks to
116	116	6 grant a third party access to:
117	117	7 (1) a provider network contract;
118	118	8 (2) dental services provided pursuant to a provider network
119	119	9 contract; or
120	120	10 (3) contractual discounts provided pursuant to a provider
121	121	11 network contract.
122	122	12 (b) Except as provided in subsection (c) and section 16 of this
123	123	13 chapter, in order for a contracting entity to grant a third party
124	124	14 access as described in subsection (a), the following conditions must
125	125	15 be satisfied:
126	126	16 (1) When a provider network contract is entered into or
127	127	17 renewed, or when there are material modifications to a
128	128	18 provider network contract relevant to granting access to a
129	129	19 third party as described in subsection (a):
130	130	20 (A) any provider that is a party to the provider network
131	131	21 contract must be allowed to choose not to participate in the
132	132	22 third party access as described in subsection (a); or
133	133	23 (B) if third party access is to be provided through the
134	134	24 acquisition of the provider network by a health insurer,
135	135	25 any provider that is a party to the provider network
136	136	26 contract must be allowed to enter into a contract directly
137	137	27 with the health insurer that acquired the provider
138	138	28 network.
139	139	29 (2) The provider network contract must specifically authorize
140	140	30 the contracting entity to enter into an agreement with third
141	141	31 parties allowing the third parties to obtain the contracting
142	142	32 entity's rights and responsibilities as if the third party were
143	143	33 the contracting entity.
144	144	34 (3) If the contracting entity seeking to grant a third party
145	145	35 access as described in subsection (a) is a dental carrier, a
146	146	36 provider that is a party to the provider network contract must
147	147	37 have chosen to participate in third party access at the time the
148	148	38 provider network contract was entered into or renewed.
149	149	39 (4) If the contracting entity seeking to grant a third party
150	150	40 access as described in subsection (a) is a health insurer, the
151	151	41 provider network contract must contain a third party access
152	152	42 provision specifically granting third party access to the
153	153	2024 IN 1351—LS 7008/DI 55 4
154	154	1 provider network.
155	155	2 (5) If the contracting entity seeking to grant a third party
156	156	3 access as described in subsection (a) is a dental carrier, the
157	157	4 provider network contract must state that the provider has a
158	158	5 right to choose not to participate in the third party access.
159	159	6 (6) The third party being granted access as described in
160	160	7 subsection (a) must agree to comply with all of the terms of
161	161	8 the provider network contract.
162	162	9 (7) The contracting entity seeking to grant third party access
163	163	10 as described in subsection (a) must identify to each provider
164	164	11 that is a party to the provider network contract, in writing or
165	165	12 electronic form, all third parties in existence as of the date on
166	166	13 which the provider network contract is entered into or
167	167	14 renewed.
168	168	15 (8) The contracting entity granting third party access as
169	169	16 described in subsection (a) must identify, in a list on its
170	170	17 website that is updated at least once every ninety (90) days, all
171	171	18 third parties to which third party access has been granted.
172	172	19 (9) If third party access as described in subsection (a) is to be
173	173	20 granted through the sale or leasing of the network established
174	174	21 by the provider network contract, the contracting entity must
175	175	22 notify all providers that are parties to the provider network
176	176	23 contract of the leasing or sale of the network at least thirty
177	177	24 (30) days before the sale or lease of the network takes effect.
178	178	25 (10) The contracting entity seeking to grant third party access
179	179	26 to contractual discounts as described in subsection (a)(3) must
180	180	27 require each third party to identify the source of the discount
181	181	28 on all remittance advices or explanations of payment under
182	182	29 which a discount is taken. However, this subdivision does not
183	183	30 apply to electronic transactions mandated by the federal
184	184	31 Health Insurance Portability and Accountability Act of 1996
185	185	32 (Public Law 104-191).
186	186	33 (c) A contracting entity may grant a third party access as
187	187	34 described in subsection (a) even if the conditions set forth in
188	188	35 subsection (b)(1) are not satisfied if the contracting entity is not a
189	189	36 health insurer or a dental carrier.
190	190	37 (d) Except as provided in subsection (c) and section 16 of this
191	191	38 chapter, a provider that is a party to a provider network contract
192	192	39 is not required to provide dental services pursuant to third party
193	193	40 access granted as described in subsection (a) unless all of the
194	194	41 applicable conditions set forth in subsection (b) are satisfied.
195	195	42 Sec. 11. A contracting entity that is a party to a provider
196	196	2024 IN 1351—LS 7008/DI 55 5
197	197	1 network contract with a provider that chooses under section
198	198	2 10(b)(1)(A) of this chapter not to participate in third party access
199	199	3 shall not alter the provider's rights or status under the provider
200	200	4 network contract because of the provider's choice not to
201	201	5 participate in third party access.
202	202	6 Sec. 12. A contracting entity that is a party to a provider
203	203	7 network contract shall notify a third party granted third party
204	204	8 access as described in section 10(a) of this chapter of the
205	205	9 termination of the provider network contract not more than thirty
206	206	10 (30) days after the date of the termination.
207	207	11 Sec. 13. The right of a third party to contractual discounts
208	208	12 described in section 10(a)(3) of this chapter ceases as of the
209	209	13 termination date of the provider network contract.
210	210	14 Sec. 14. A contracting entity that is a party to a provider
211	211	15 network contract shall make a copy of the provider network
212	212	16 contract relied on in the adjudication of a claim available to a
213	213	17 participating provider not more than thirty (30) days after the date
214	214	18 of the participating provider's request.
215	215	19 Sec. 15. When entering into a provider network contract with
216	216	20 providers, a contracting entity shall not reject a provider as a
217	217	21 party to the provider network contract because the provider
218	218	22 chooses or has chosen under section 10(b)(1)(A) of this chapter not
219	219	23 to participate in third party access.
220	220	24 Sec. 16. (a) Section 10 of this chapter does not apply to access as
221	221	25 described in section 10(a) of this chapter if granted by a
222	222	26 contracting entity to:
223	223	27 (1) a dental carrier or other entity operating in accordance
224	224	28 with the same brand licensee program as the contracting
225	225	29 entity; or
226	226	30 (2) an entity that is an affiliate of the contracting entity.
227	227	31 (b) For the purposes of this section, a contracting entity shall
228	228	32 make a list of the contracting entity's affiliates available to
229	229	33 providers on the contracting entity's website.
230	230	34 (c) Section 10 of this chapter does not apply to a provider
231	231	35 network contract established for the purpose of providing dental
232	232	36 services to beneficiaries of health programs sponsored by the state,
233	233	37 including Medicaid (IC 12-15) and the children's health insurance
234	234	38 program (IC 12-17.6).
235	235	39 Sec. 17. The provisions of this chapter cannot be waived by
236	236	40 contract. A contract provision that:
237	237	41 (1) conflicts with this chapter; or
238	238	42 (2) purports to waive any requirements of this chapter;
239	239	2024 IN 1351—LS 7008/DI 55 6
240	240	1 is null and void.
241	241	2 Sec. 18. (a) If a person violates this chapter, the insurance
242	242	3 commissioner may enter an order requiring the person to cease
243	243	4 and desist from violating this chapter.
244	244	5 (b) If a person violates a cease and desist order issued under
245	245	6 subsection (a), the insurance commissioner, after notice and
246	246	7 hearing under IC 4-21.5, may:
247	247	8 (1) impose a civil penalty upon the person of not more than
248	248	9 ten thousand dollars ($10,000) for each day of violation;
249	249	10 (2) suspend or revoke the person's certificate of authority, if
250	250	11 the person holds a certificate of authority under this title; or
251	251	12 (3) both impose a civil penalty upon the person under
252	252	13 subdivision (1) and suspend or revoke the person's certificate
253	253	14 of authority under subdivision (2).
254	254	15 SECTION 2. IC 27-8-11-14 IS ADDED TO THE INDIANA CODE
255	255	16 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
256	256	17 1, 2024]: Sec. 14. (a) As used in this section, "dental services"
257	257	18 means health care services provided by:
258	258	19 (1) a dentist licensed under IC 25-14;
259	259	20 (2) an individual using a dental residency permit issued under
260	260	21 IC 25-14-1-5;
261	261	22 (3) an individual who holds:
262	262	23 (A) a dental faculty license under IC 25-14-1-5.5; or
263	263	24 (B) an instructor's license under IC 25-14-1-27.5;
264	264	25 (4) a dental hygienist licensed under IC 25-13; or
265	265	26 (5) a dental assistant, as defined in IC 25-14-1-1.5(4).
266	266	27 (b) If an insured assigns the rights of the insured to benefits for
267	267	28 dental services to the provider of the dental services, the insurer
268	268	29 shall pay the benefits assigned by the insured to the provider of the
269	269	30 dental services.
270	270	31 (c) An insurer shall make a payment under this section:
271	271	32 (1) directly to the provider of the dental services; and
272	272	33 (2) according to the same criteria and payment schedule
273	273	34 under which the insurer would have been required to make
274	274	35 the payment to the insured if the insured had not assigned the
275	275	36 insured's rights to the benefits.
276	276	37 (d) An assignment of benefits under this section does not affect
277	277	38 or limit the insurer's obligation to pay the benefits.
278	278	39 (e) An insurer's payment of benefits in compliance with this
279	279	40 section discharges the insurer's obligation to pay the benefits to the
280	280	41 insured.
281	281	2024 IN 1351—LS 7008/DI 55