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HOUSE DOCKET, NO. 3365 FILED ON: 1/20/2023
HOUSE . . . . . . . . . . . . . . . No. 1111
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Alice Hanlon Peisch
_________________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act relative to a dental patient bill of rights.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :DATE ADDED:Alice Hanlon Peisch14th Norfolk1/12/2023 1 of 3
HOUSE DOCKET, NO. 3365 FILED ON: 1/20/2023
HOUSE . . . . . . . . . . . . . . . No. 1111
By Representative Peisch of Wellesley, a petition (accompanied by bill, House, No. 1111) of
Alice Hanlon Peisch relative to a dental insurance. Financial Services.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE HOUSE, NO. 1173 OF 2021-2022.]
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
An Act relative to a dental patient bill of rights.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 Chapter 176X of the General Laws, as appearing in the 2020 Official Edition, are hereby
2amended by adding the following chapter:-
3 Chapter 176Y
4 SECTION 1. DISCLOSURE OF BENEFIT TERMS.
5 (a) An employee benefit plan or health insurance policy shall: (1) if applicable, disclose
6that the benefit for dental care services offered is limited to the least costly treatment; and (2)
7specify in dollars and cents the amount of the payment or reimbursement to be provided for
8dental care services or define AND explain the standard on which payment of benefits or
9reimbursement for the cost of dental care services is based, such as: (A) "usual and customary" 2 of 3
10fees; (B) "reasonable and customary fees; (C) "usual, customary, and reasonable" fees; or (D)
11preset fee schedule or (E) words of similar meaning.
12 (b) A person or entity who provides or issues an employee benefit plan or health
13insurance policy or the employer or employee organization, if applicable, shall establish an
14Internet website to provide resources and accurate information to dentists, insureds, participants,
15employees, and members, including the standard on which reimbursement is based.
16 (c) An employee benefit plan or health insurance policy shall make accessible on the
17Internet website established under subsection (b) information about the plan or policy sufficient
18for patients and dentists to determine the type of dental care services covered by the plan or
19policy and the amount of the payment or reimbursement available for those services under the
20plan or policy. Access to the Internet website must be at no charge to patients under the plan or
21policy and dentists providing dental care services to the patients whether in network or out of
22network.
23 SECTION 2.
24 (a) The employee benefit plan or health insurance policy shall: (1) provide: (A) that
25payment or reimbursement for a noncontracting provider dentist shall be the same or greater as
26payment or reimbursement for a contracting provider dentist; (B) that the party to or
27beneficiary of the plan or policy may assign the right to payment or reimbursement to the
28dentist who provides the dental care services; and (C) one or more methods of payment or
29reimbursement that provide the dentist 100 percent of the contracted amount of the payment or
30reimbursement and that do not require the dentist to incur a fee to access the payment or
31reimbursement; and (2) disclose on the Internet website required under and on request of a 3 of 3
32dentist or a party to or beneficiary of the plan or policy the fees, if any, associated with the
33methods of payment or reimbursement available under the plan or policy.
34 SECTION 3.
35 (a) An employee benefit plan or health insurance policy may not: (1) interfere with or
36prevent an individual who is a party to or beneficiary of the plan or policy from selecting a
37dentist of the individual's choice to provide a dental care service the plan or policy offers if the
38dentist selected is licensed in this state to provide the service; (2) deny a dentist the right to
39participate as a contracting provider under the plan or policy if the dentist is licensed to provide
40the dental care services the plan or policy offers; (3) authorize a person to regulate, interfere
41with, or intervene in the provision of dental care services a dentist provides a patient, including
42diagnosis, if the dentist practices within the scope of the dentist's license; (4) require a dentist
43to make or obtain a dental x-ray or other diagnostic aid in providing dental care services; or (5)
44deduct the amount of an overpayment of a claim from a payment or reimbursement of another
45claim unless both claims were for dental services provided to the same patient by the same
46dentist.
47 (b) This section does not prohibit the predetermination of benefits for dental care
48expenses before the attending dentist provides treatment. An employee benefit plan or health
49insurance policy that provides a written predetermination of benefits to a dentist with respect to a
50dental care service for a patient that includes a specific benefit payment or reimbursement
51amount may not pay or reimburse the dentist for providing that service to the patient in an
52amount that is less than the amount set forth in the predetermination.