Kansas 2025-2026 Regular Session

Kansas House Bill HB2247 Compare Versions

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

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1	1	Session of 2025
2	2	HOUSE BILL No. 2247
3	3	By Committee on Health and Human Services
4	4	Requested by Representative Reavis on behalf of the Kansas Dental Association
5	5	2-4
6	6	AN ACT concerning insurance; relating to contracts between an insurer
7	7	and a dental healthcare provider; requiring reviews, audits or
8	8	investigations be completed within six months; prohibiting denial for
9	9	claims submitted by dentists for procedures included in a prior
10	10	authorization; amending K.S.A. 40-2,185 and repealing the existing
11	11	section.
12	12	Be it enacted by the Legislature of the State of Kansas:
13	13	New Section 1. (a) Except as otherwise provided, any review, audit or
14	14	investigation by a nonprofit dental service corporation concerning
15	15	healthcare provider claims that result in the recoupment or setoff of funds
16	16	previously paid to the healthcare provider shall be completed not more
17	17	than six months after the completed claims were initially paid.
18	18	(b) This section shall not restrict any review, audit or investigation
19	19	concerning the following:
20	20	(1) Fraudulently submitted claims;
21	21	(2) claims that the healthcare provider knew, or should have known,
22	22	to be a pattern of inappropriate billing according to the standards of the
23	23	respective dental or medical specialty;
24	24	(3) claims that are related to the coordination of benefits; or
25	25	(4) claims that are subjected to any federal law or regulation that
26	26	permits claims review beyond the specified period in subsection (a).
27	27	New Sec. 2. (a) As used in this section:
28	28	(1) "Prior authorization" means any written communication by a
29	29	dental benefit plan or utilization review entity indicating that a specific
30	30	procedure is covered under the patient's dental plan and is reimbursable at
31	31	a specific amount, subject to the applicable coinsurance and deductibles,
32	32	and is issued in response to a request submitted by a dentist using a format
33	33	prescribed by the health insurer.
34	34	(2) "Utilization review entity" means an individual or entity that
35	35	performs prior authorization for:
36	36	(A) An employer with employees in Kansas who are covered under a
37	37	health benefit plan or health insurance policy;
38	38	(B) an insurer that writes health insurance policies;
39	39	(C) a preferred provider organization or health maintenance
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75	75	organization; or
76	76	(D) any other individual or entity that provides, offers to provide or
77	77	administers hospital, outpatient, medical, prescription drug or other health
78	78	benefits to a person treated by a healthcare professional in Kansas under a
79	79	policy, plan or contract.
80	80	(b) A dental benefit plan or utilization review entity shall not deny a
81	81	claim submitted by a dentist for procedures specifically included in a prior
82	82	authorization, unless for each procedure denied:
83	83	(1) Benefit limitations, including annual maximums and frequency
84	84	limitations, that were not applicable at the time of the prior authorization
85	85	are reached due to utilization subsequent to the issuance of the prior
86	86	authorization;
87	87	(2) the documentation for the claim provided by the person
88	88	submitting the claim clearly fails to support the claim as originally
89	89	authorized;
90	90	(3) new procedures are provided to the patient subsequent to the
91	91	issuance of the prior authorization or the patient's condition changes such
92	92	that the prior authorized procedure would no longer be considered
93	93	medically necessary based on the prevailing standard of care; or
94	94	(4) new procedures are provided to the patient subsequent to the
95	95	issuance of the prior authorization or the patient's condition changes such
96	96	that the prior authorized procedure would presently require disapproval.
97	97	Sec. 3. K.S.A. 40-2,185 is hereby amended to read as follows: 40-
98	98	2,185. No contract issued or renewed after July 1, 2010, between a health
99	99	insurer and a dentist who is a participating provider with respect to such
100	100	health insurer's health benefit plan shall contain any provision which that
101	101	requires the dentist who provides to provide any service to an insured
102	102	under such health benefit plan at a fee set or prescribed by the health
103	103	insurer unless such service is a covered service.
104	104	(b) A contract between an insurer and a dentist shall not:
105	105	(1) Limit the fee that the dentist may charge for a service that is not a
106	106	covered service; or
107	107	(2) include a provision that both:
108	108	(A) Allows the insurer to disallow a service, resulting in denial of
109	109	payment to the dentist for a service that ordinarily would have been
110	110	covered; and
111	111	(B) prohibits the dentist from billing for and collecting the amount
112	112	owed from the patient for such service if there is a dental necessity for
113	113	such service.
114	114	(c) As used in this section, "dental necessity" means whether a
115	115	prudent dentist, acting in accordance with generally accepted practices of
116	116	the professional dental community and within the American dental
117	117	association's parameters of care for dentistry and the quality assurance
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161	161	criteria of the American academy of pediatric dentistry, as applicable,
162	162	would provide the service or product to a patient to diagnose, prevent or
163	163	treat orofacial pain, infection, disease, dysfunction or disfiguration.
164	164	Sec. 4. K.S.A. 40-2,185 is hereby repealed.
165	165	Sec. 5. This act shall take effect and be in force from and after its
166	166	publication in the statute book.
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