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.
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)