Louisiana 2021 2021 Regular Session

Louisiana House Bill HB387 Comm Sub / Analysis

                    SSHB387 3264 3189
HOUSE SUMMARY OF SENATE AMENDMENTS
HB 387	2021 Regular Session	Green
INSURERS:  Provides relative to network leasing by dental insurers
Synopsis of Senate Amendments
1.Applies proposed law to any contract issued or renewed after August 1, 2021.
Digest of Bill as Finally Passed by Senate
Abstract:  Creates the Network Leasing Act to provide for contractual regulations 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.
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 in writing or
electronic form 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.
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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.
Proposed law applies to any contract issued or renewed after August 1, 2021.
(Adds R.S. 22:1171 and 1172)
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