Kansas 2023-2024 Regular Session

Kansas House Bill HB2752 Compare Versions

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

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1	1	Session of 2024
2	2	HOUSE BILL No. 2752
3	3	By Committee on Insurance
4	4	Requested by Kevin Robertson on behalf of the Kansas Dental Association
5	5	2-7
6	6	AN ACT concerning health insurance; relating to dental benefit plans and
7	7	services; establishing the dental ratio act; requiring the calculation of
8	8	the annual dental loss ratio by each dental benefit plan; requiring each
9	9	dental benefit plan to file an annual report; rebating certain dollar
10	10	amounts to insureds or plan administrators when the dental loss ratio
11	11	percentage does not meet the required loss ratio percentage; authorizing
12	12	the commissioner to adopt rules and regulations.
13	13	Be it enacted by the Legislature of the State of Kansas:
14	14	Section 1. (a) Sections 1 through 6, and amendments thereto, shall be
15	15	known and may be cited as the dental loss ratio act.
16	16	(b) As used in this act:
17	17	(1) "Act" means the dental loss ratio act.
18	18	(2) "Actual patient care" means the amount that a dental benefit plan
19	19	expends on clinical dental services.
20	20	(3) "Clinical dental services" means services within the code on
21	21	dental procedures and nomenclature that are provided to insureds.
22	22	"Clinical dental services" includes payments under capitation contracts
23	23	with dental providers whose services or supplies are covered by the
24	24	contract.
25	25	(4) "Commissioner" means the commissioner of insurance.
26	26	(5) "Dental benefit plan" means the plan or dental portion of a health
27	27	benefit plan that issues, sells, renews or offers a specialized health benefit
28	28	plan contract covering dental services.
29	29	(6) (A) "Dental loss ratio" means the percentage of premium dollars
30	30	collected each year for a dental benefit plan that the dental benefit plan
31	31	incurs on clinical dental services provided to an insured, separate from
32	32	overhead and administrative costs.
33	33	(B) "Dental loss ratio" is determined by dividing the numerator by the
34	34	denominator, where:
35	35	(i) (a) The numerator is the amount spent on actual patient care
36	36	including the total amount expended by the dental benefit plan for clinical
37	37	dental services and unpaid claims reserves, less any overpayment
38	38	recoveries received by providers and any claim payments recovered by
39	39	utilization management.
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75	75	(b) The numerator does not include: (1) Administrative costs,
76	76	including, but not limited to, infrastructure, personnel costs or broker
77	77	payments; (2) amounts paid to third-party vendors for secondary network
78	78	savings, network development, administrative fees, claims processing or
79	79	utilization management; and (3) amounts paid to providers for professional
80	80	or administrative services that do not represent compensation or
81	81	reimbursement for covered services provided to an insured, including, but
82	82	not limited to, dental record copying costs, attorney fees, subrogation
83	83	vendor fees, compensation to paraprofessionals, janitors, quality assistance
84	84	analysts, administrative supervisors, secretaries and dental record clerks.
85	85	(ii) (a) The denominator is the total amount of earned premium
86	86	revenues and is calculated using dental benefit plan revenue.
87	87	(b) The denominator does not include: (1) Federal and state taxes;
88	88	and (2) licensing and regulatory fees paid after accounting for any
89	89	payments made pursuant to federal law.
90	90	(7) "Dental loss ratio percentage" means the dental loss ratio
91	91	expressed as a percentage of a dental benefit plan.
92	92	(8) "Department" means the Kansas insurance department.
93	93	(9) "Earned premium revenues" means all moneys paid by an insured
94	94	as a condition of receiving coverage from the dental benefit plan,
95	95	including any fees and other contributions associated with such dental
96	96	benefit plan.
97	97	(10) "Required dental loss ratio percentage" means the minimum
98	98	percentage that a dental loss ratio of a dental benefit plan must meet in
99	99	order to avoid issuing rebates. The "required dental loss ratio percentage"
100	100	may be adjusted by the commissioner from time to time.
101	101	Sec. 2. (a) Every dental benefit plan shall file a dental loss ratio
102	102	annual report with the Kansas insurance department. Such report shall be
103	103	organized by market and product type and, where appropriate, contain the
104	104	same information required in the 2013 federal medical loss ratio annual
105	105	reporting form, known as the CMS-10418.
106	106	(b) The dental loss ratio annual reporting year shall be for the
107	107	calendar year during which dental coverage is provided by the dental
108	108	benefit plan. All terms used in the dental loss ratio annual report shall have
109	109	the same meaning as used in the federal public health service act, 42
110	110	U.S.C. § 300gg-18, part 158 of title 45 of the code of federal regulations.
111	111	(c) The dental benefit plan or the dental portion of a health benefit
112	112	plan shall have 30 days from the date of notification to submit all
113	113	requested data to the department. The commissioner may extend the time
114	114	for a dental benefit plan to comply with this subsection upon a finding of
115	115	good cause.
116	116	(d) Data provided to the department pursuant to this section shall be
117	117	subject to the provisions of the Kansas open records act, K.S.A. 45-215 et
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161	161	seq., and amendments thereto.
162	162	Sec. 3. (a) On and after July 1, 2025, the required dental loss ratio
163	163	shall be 85%.
164	164	(b) If the dental benefits plan dental loss ratio percentage, as
165	165	calculated pursuant to section 1, and amendments thereto, is less than the
166	166	required dental loss ratio percentage, the dental benefit plan shall return
167	167	the dollar amount reflecting the monetary difference between the required
168	168	dental loss ratio percentage and the dental benefit plan's actual dental loss
169	169	ratio percentage in the form of a rebate.
170	170	(c) Any rebate shall be issued on a pro rata basis to:
171	171	(1) Each individual insured who is enrolled in the dental benefit plan;
172	172	or
173	173	(2) (A) the plan administrator of each organization with enrollees in
174	174	the dental benefit plan; and
175	175	(B) if the rebate is returned to the plan administrator, then the entire
176	176	amount of such rebate shall be used only to defray the premiums of the
177	177	insureds enrolled in such dental plan for the next plan year.
178	178	Sec. 4. (a) All carriers offering dental benefit plans shall file group
179	179	product base rates and any changes to group rating factors that are to be
180	180	effective on January 1 of each year, on or before July 1 of the preceding
181	181	year. The department shall disapprove any proposed changes to base rates
182	182	that are excessive, inadequate or unreasonable in relation to the benefits
183	183	charged. The department shall disapprove any change to group rating
184	184	factors that is discriminatory or not actuarially sound.
185	185	(b) The carrier's rate shall be presumptively disapproved by the
186	186	department if:
187	187	(1) A carrier files a base rate change and the administrative expense
188	188	loading component, not including taxes and assessments, increases by
189	189	more than the most recent calendar year's percentage increase in the dental
190	190	services consumer price index for all urban consumers, United States city
191	191	average, not seasonally adjusted;
192	192	(2) a carrier's reported contribution to surplus exceeds 1.9%; or
193	193	(3) the aggregate medical loss ratio for all plans offered by a health
194	194	insurer is less than the required dental loss ratio percent.
195	195	(c) If a proposed rate change has been presumptively disapproved:
196	196	(1) A carrier shall communicate to all employers and individuals
197	197	covered under a group product that the proposed increase has been
198	198	presumptively disapproved and is subject to a hearing by the department;
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200	200	(2) the department shall conduct a public hearing and shall properly
201	201	advertise the hearing in compliance with public hearing requirements.
202	202	(d) If the department disapproves the proposed rate change submitted
203	203	by a carrier, the department shall notify the carrier in writing not later than
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247	247	45 days prior to the proposed effective date of the carrier's rate. The carrier
248	248	may submit a request for a hearing to the department within 10 days of
249	249	such notice of disapproval. The department shall schedule a hearing within
250	250	15 days upon receipt of the request for hearing. The department shall issue
251	251	a written decision within 30 days after the conclusion of the hearing. The
252	252	carrier shall not implement the disapproved rates or changes at any time
253	253	unless the department reverses the disapproval after a hearing or unless a
254	254	court vacates the department's decision.
255	255	Sec. 5. The commissioner may adopt such rules and regulations as are
256	256	necessary to implement and administer this act.
257	257	Sec. 6. This act shall not apply to health benefit plans for healthcare
258	258	services under medicaid, the children's health insurance program or any
259	259	other state-sponsored health program.
260	260	Sec. 7. This act shall take effect and be in force from and after July 1,
261	261	2025 and its publication in the statute book.
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