Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S697 Compare Versions

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

Old	New	Differences
1	1	1 of 1
2	2	SENATE DOCKET, NO. 1345 FILED ON: 1/19/2023
3	3	SENATE . . . . . . . . . . . . . . No. 697
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Patrick M. O'Connor
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act relative to dental insurance consumer protections.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :Patrick M. O'ConnorFirst Plymouth and Norfolk 1 of 3
16	16	SENATE DOCKET, NO. 1345 FILED ON: 1/19/2023
17	17	SENATE . . . . . . . . . . . . . . No. 697
18	18	By Mr. O'Connor, a petition (accompanied by bill, Senate, No. 697) of Patrick M. O'Connor for
19	19	legislation relative to dental insurance consumer protections. Financial Services.
20	20	The Commonwealth of Massachusetts
21	21	_______________
22	22	In the One Hundred and Ninety-Third General Court
23	23	(2023-2024)
24	24	_______________
25	25	An Act relative to dental insurance consumer protections.
26	26	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
27	27	of the same, as follows:
28	28	1 Chapter 176X of the General Laws, as appearing in the 2020 Official Edition, are hereby
29	29	2amended by adding the following chapter:-
30	30	3 Chapter 176Y
31	31	4 SECTION 1. DISCLOSURE OF BENEFIT TERMS.
32	32	5 (a) An employee benefit plan or health insurance policy shall: (1) if applicable, disclose
33	33	6that the benefit for dental care services offered is limited to the least costly treatment; and (2)
34	34	7specify in dollars and cents the amount of the payment or reimbursement to be provided for
35	35	8dental care services or define AND explain the standard on which payment of benefits or
36	36	9reimbursement for the cost of dental care services is based, such as: (A) "usual and customary"
37	37	10fees; (B) "reasonable and customary fees; (C) "usual, customary, and reasonable" fees; or (D)
38	38	11preset fee schedule or (E) words of similar meaning. 2 of 3
39	39	12 (b) A person or entity who provides or issues an employee benefit plan or health
40	40	13insurance policy or the employer or employee organization, if applicable, shall establish an
41	41	14Internet website to provide resources and accurate information to dentists, insureds, participants,
42	42	15employees, and members, including the standard on which reimbursement is based.
43	43	16 (c) An employee benefit plan or health insurance policy shall make accessible on the
44	44	17Internet website established under subsection (b) information about the plan or policy sufficient
45	45	18for patients and dentists to determine the type of dental care services covered by the plan or
46	46	19policy and the amount of the payment or reimbursement available for those services under the
47	47	20plan or policy. Access to the Internet website must be at no charge to patients under the plan or
48	48	21policy and dentists providing dental care services to the patients whether in network or out of
49	49	22network.
50	50	23 SECTION 2.
51	51	24 (a) The employee benefit plan or health insurance policy shall: (1) provide: (A) that
52	52	25payment or reimbursement for a noncontracting provider dentist shall be the same or greater as
53	53	26payment or reimbursement for a contracting provider dentist; (B) that the party to or
54	54	27beneficiary of the plan or policy may assign the right to payment or reimbursement to the
55	55	28dentist who provides the dental care services; and (C) one or more methods of payment or
56	56	29reimbursement that provide the dentist 100 percent of the contracted amount of the payment or
57	57	30reimbursement and that do not require the dentist to incur a fee to access the payment or
58	58	31reimbursement; and (2) disclose on the Internet website required under and on request of a
59	59	32dentist or a party to or beneficiary of the plan or policy the fees, if any, associated with the
60	60	33methods of payment or reimbursement available under the plan or policy. 3 of 3
61	61	34 SECTION 3.
62	62	35 (a) An employee benefit plan or health insurance policy may not: (1) interfere with or
63	63	36prevent an individual who is a party to or beneficiary of the plan or policy from selecting a
64	64	37dentist of the individual's choice to provide a dental care service the plan or policy offers if the
65	65	38dentist selected is licensed in this state to provide the service; (2) deny a dentist the right to
66	66	39participate as a contracting provider under the plan or policy if the dentist is licensed to provide
67	67	40the dental care services the plan or policy offers; (3) authorize a person to regulate, interfere
68	68	41with, or intervene in the provision of dental care services a dentist provides a patient, including
69	69	42diagnosis, if the dentist practices within the scope of the dentist's license; (4) require a dentist
70	70	43to make or obtain a dental x-ray or other diagnostic aid in providing dental care services; or (5)
71	71	44deduct the amount of an overpayment of a claim from a payment or reimbursement of another
72	72	45claim unless both claims were for dental services provided to the same patient by the same
73	73	46dentist.
74	74	47 (b) This section does not prohibit the predetermination of benefits for dental care
75	75	48expenses before the attending dentist provides treatment. An employee benefit plan or health
76	76	49insurance policy that provides a written predetermination of benefits to a dentist with respect to a
77	77	50dental care service for a patient that includes a specific benefit payment or reimbursement
78	78	51amount may not pay or reimburse the dentist for providing that service to the patient in an
79	79	52amount that is less than the amount set forth in the predetermination.