HLS 21RS-573 ORIGINAL
2021 Regular Session
HOUSE BILL NO. 387
BY REPRESENTATIVE GREEN
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURERS: Provides relative to network leasing by dental insurers
1 AN ACT
2To enact Subpart H-1 of Part III of Chapter 4 of Title 22 of the Louisiana Revised Statutes
3 of 1950, to be comprised of R.S. 22:1171 and 1172, relative to dental provider
4 network administration; to enhance contractual transparency and options in network
5 leasing; to provide for definitions; to prohibit certain contracts and waivers; to
6 require notifications; to provide for applicability; to provide for penalties and
7 enforcement; to authorize rulemaking; and to provide for related matters.
8Be it enacted by the Legislature of Louisiana:
9 Section 1. Subpart H-1 of Part III of Chapter 4 of Title 22 of the Louisiana Revised
10Statutes of 1950, comprised of R.S. 22:1171 and 1172, is hereby enacted to read as follows:
11 SUBPART H-1. NETWORK LEASING ACT
12 §1171. Short title; definitions
13 A. This Subpart may be cited as the "Network Leasing Act".
14 B. As used in this Subpart, the following definitions apply:
15 (1) "Contracting entity" means any person or entity, including a third-party
16 administrator and a dental carrier, that enters into a direct contract with a provider
17 for the delivery of dental services in the ordinary course of business.
18 (2) "Dental benefit plan" means a benefit plan which pays or provides dental
19 expense benefits for covered dental services and is delivered or issued for delivery
20 by or through a dental carrier on a stand-alone basis.
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1 (3) "Dental carrier" means a dental insurance company, dental service
2 corporation, dental plan organization authorized to provide dental benefits, or a
3 health insurance plan that includes coverage for dental services.
4 (4) "Dental services" means services for the diagnosis, prevention, treatment,
5 or cure of a dental condition, illness, injury, or disease. "Dental services" does not
6 include services delivered by a provider that are billed as medical expenses per the
7 terms of a health insurance plan.
8 (5) "Dentist" means any person lawfully licensed by the Louisiana State
9 Board of Dentistry to practice dentistry in this state.
10 (6) "Health insurance plan" means any hospital or medical insurance policy
11 or certificate, qualified higher deductible health plan, health maintenance
12 organization subscriber contract, contract providing benefits for dental care whether
13 such contract is pursuant to a medical insurance policy or certificate, stand-alone
14 dental plan, health maintenance provider contract, or managed healthcare plan.
15 (7) "Health insurer" means any entity or person that issues health insurance
16 plans as described in this Section.
17 (8) "Provider" means an individual or entity which, acting within the scope
18 of licensure or certification, provides dental services or supplies defined by the
19 health insurance plan or dental benefit plan. "Provider" does not include a physician
20 organization or physician hospital organization that leases or rents the physician
21 organization's or physician hospital organization's network to a third party.
22 (9) "Provider network contract" means a contract between a contracting
23 entity and a provider that specifies the rights and responsibilities of the contracting
24 entity and provides for the delivery and payment of dental services to an enrollee.
25 (10) "Third party" means a person or entity that enters into a contract with
26 a contracting entity or with another third party to gain access to the dental services
27 or contractual discounts of a provider network contract. "Third party" does not
28 include an employer or other group for whom the dental carrier or contracting entity
29 provides administrative services.
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HB NO. 387
1 §1172. Fair and transparent network contracting; responsible leasing requirements;
2 applicability; penalties; enforcement; waiver of contractual regulations
3 prohibited; rules and regulations
4 A. A contracting entity may grant a third party access to a provider network
5 contract or a provider’s dental services or contractual discounts pursuant to a
6 provider network contract if all of the following terms are met:
7 (1) The contract specifically states that the contracting entity may enter into
8 an agreement with a third party allowing the third party to obtain the contracting
9 entity's rights and responsibilities as if the third party is the contracting entity.
10 (a) If the contracting entity is a dental carrier, the provider chose to
11 participate in third-party access at the time the provider network contract was entered
12 into or renewed, and for contracts with dental carriers, the dentist has the right to
13 choose not to participate in third-party access.
14 (b) If the contracting entity is an insurer, the third-party access provision of
15 any provider network contract specifically states that the contract grants third-party
16 access to the provider network.
17 (2) The third party accessing the contract agrees to comply with all terms of
18 the provider network contract.
19 (3) The contracting entity identifies, in writing or electronic form to the
20 provider, all third parties in existence as of the date the contract is entered into or
21 renewed.
22 (4) The contracting entity identifies all third parties in existence in a list on
23 its internet website that is updated at least once every ninety days.
24 (5) The contracting entity notifies network providers that a new third party
25 is leasing or purchasing the network at least thirty days in advance of the relationship
26 taking effect.
27 (6)(a) The contracting entity requires a third party to identify the source of
28 the discount on all remittance advices or explanations of payment under which a
29 discount is taken.
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1 (b) The provisions of this Paragraph do not apply to electronic transactions
2 mandated by the Health Insurance Portability and Accountability Act of 1996.
3 (7) The contracting entity notifies the third party of the termination of a
4 provider network contract no later than thirty days from the termination date with the
5 contracting entity.
6 (8) A third party’s right to a provider’s discounted rate ceases as of the
7 termination date of the provider network contract.
8 (9) The contracting entity makes available a copy of the provider network
9 contract relied on in the adjudication of a claim to a participating provider within
10 thirty days of a request from the provider.
11 B.(1) At the time the provider network contract is entered into or renewed,
12 or when there are material modifications to a contract relevant to granting access of
13 a provider network contract to a third party, a dental carrier shall allow any provider
14 which is part of the carrier's provider network to choose not to participate in third-
15 party access to the contract or to enter into a contract directly with the health insurer
16 that acquired the provider network. If a provider opts out of a network lease
17 arrangement, this does not permit the contracting entity to cancel or otherwise end
18 a contractual relationship with the provider. When initially contracting with a
19 provider, a contracting entity shall accept a qualified provider even if a provider
20 rejects a network lease provision.
21 (2) The provisions of this Subsection do not apply to a contracting entity that
22 is not a health insurer or dental carrier.
23 C. A provider is not bound by or required to perform dental treatment or
24 services pursuant to a provider network contract that has been granted to a third party
25 in violation of this Subpart.
26 D. Applicability. The provisions of this Section do not apply if either of the
27 following is true:
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1 (1)(a) Access to a provider network contract is granted to a dental carrier or
2 an entity operating in accordance with the same brand licensee program as the
3 contracting entity or to an entity that is an affiliate of the contracting entity.
4 (b) A contracting entity shall make available to a provider on its website a
5 list of the contracting entity's affiliates.
6 (2) A provider network contract for dental services is provided to
7 beneficiaries of state-sponsored Medicaid and LaCHIP programs.
8 E. Penalties. The commissioner of insurance shall enforce the provisions of
9 this Subpart and impose any penalty or remedy authorized by this Title against any
10 violator of the provisions of this Subpart.
11 F. The provisions of this Subpart cannot be waived by contract. Any
12 contractual arrangement in conflict with the provisions of this Subpart or that
13 purports to waive any requirement of this Subpart is of no effect.
14 G. The commissioner of insurance may promulgate rules in accordance with
15 the Administrative Procedure Act that are consistent with the provisions of this
16 Subpart and the laws of this state.
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 387 Original 2021 Regular Session Green
Abstract: Creates the Network Leasing Act to enhance contractual transparency between
dental carriers, dentists, and third parties.
Proposed law defines "contracting entity", "dental benefit plan", "dental carrier", "dental
services","dentist", "health insurance plan", "health insurer", "provider", "provider network
contract", and "third party".
Proposed law authorizes a contracting entity to grant a third party access to a provider
network contract or a provider's dental services or contractual discounts if certain contractual
requirements are met. Further requires the contract to specifically state that the contracting
entity may contractually allow a third party to obtain the contracting entity's rights and
responsibilities as if the contracting entity and the third party are one.
Proposed law requires that if the contracting entity is a dental carrier, the carrier shall have
chosen to participate in third-party access at the time the provider network contract was
entered into or renewed and, for contracts with dental carriers, a dentist may opt not to
participate in third-party access.
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Proposed law requires that if the contracting entity is an insurer, the third-party access
provision of any provider network contract shall also specifically state that the contract
grants third-party access to the provider network.
Proposed law requires the third party accessing the contract to comply with all terms of the
provider network contract. Requires the contracting entity to provide written or electronic
notification to the provider of all third parties in existence as of the date of the contract or
subsequent renewal. Further requires the contracting entity to identify all third parties in
existence in a list on its internet website at least once every 90 days.
Proposed law requires the contracting entity to notify network providers that a new third
party is leasing or purchasing the network at least 30 days prior to the relationship taking
effect.
Proposed law requires the contracting entity to cause a third party to identify the source of
the discount on all remittance advices or explanations of payment under which a discount
is taken. This provision of proposed law does not apply to electronic transactions mandated
by the HIPAA Act of 1996.
Proposed law requires the contracting entity to notify the third party of termination of a
provider network contract no later than 30 days from the termination date with the
contracting entity. Further provides that the third party's right to a provider's discounted rate
ceases as of the termination date of the provider network contract.
Proposed law requires the contracting entity to make available a copy of the provider
network contract relied on in the adjudication of a claim to a participating provider within
30 days of a request from the provider.
Proposed law requires a dental carrier to allow any provider which is part of the carrier's
provider network to opt not to participate in third-party access to the contract or to enter into
a contract directly with the health insurer that acquired the provider network. Prohibits a
contracting entity from canceling or otherwise ending a contractual relationship on the basis
that a provider opts out of a lease arrangement. Further requires a contracting entity to
accept a qualified provider even if a provider rejects a network lease option. These
provisions of proposed law do not apply to a contracting entity that is not a health insurer
or dental carrier.
Proposed law provides that a provider is not bound by or required to perform dental
treatment or services per the terms of a provider network contract that has been granted to
a third party in violation of proposed law.
Proposed law does not apply if access to a provider network contract is granted to a dental
carrier or an entity operating in accordance with the same brand licensee program as the
contracting entity or to an entity that is an affiliate of the contracting entity, or if the provider
network contract for dental services is provided to beneficiaries of state-sponsored Medicaid
and LaCHIP programs.
Proposed law prohibits waiver of contractual provisions. Any contractual arrangement in
conflict with proposed law or that purports to waive any requirement is of no effect.
Proposed law authorizes the commissioner of insurance to promulgate rules in accordance
with the APA that are consistent with proposed law and the laws of this state, and requires
enforcement of penalties for violations.
(Adds R.S. 22:1171 and 1172)
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