Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1306 Compare Versions

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

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1	1	1 of 1
2	2	HOUSE DOCKET, NO. 3892 FILED ON: 1/17/2025
3	3	HOUSE . . . . . . . . . . . . . . . No. 1306
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Daniel J. Ryan
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 ensuring transparency in the practice of dental leased networks.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Daniel J. Ryan2nd Suffolk1/17/2025 1 of 6
16	16	HOUSE DOCKET, NO. 3892 FILED ON: 1/17/2025
17	17	HOUSE . . . . . . . . . . . . . . . No. 1306
18	18	By Representative Ryan of Boston, a petition (accompanied by bill, House, No. 1306) of Daniel
19	19	J. Ryan relative to dental leased networks. Financial Services.
20	20	The Commonwealth of Massachusetts
21	21	_______________
22	22	In the One Hundred and Ninety-Fourth General Court
23	23	(2025-2026)
24	24	_______________
25	25	An Act ensuring transparency in the practice of dental leased networks.
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 The General Laws are hereby amended by inserting after Chapter 176X the following
29	29	2chapter:
30	30	3 Chapter 176Y
31	31	4 Section 1. For the purpose of Chapter 176Y, the following words shall have the following
32	32	5meanings:
33	33	6 “Provider Network Entity” means any person or entity, including a Carrier, that: (i)
34	34	7contracts with Participating Dental Providers and has a direct written agreement with such
35	35	8Participating Dental Providers for the delivery of healthcare services or benefits; or (ii) sells,
36	36	9rents, leases, or grants access to Dental Networks to Third-party Health Plans.
37	37	10 ”Third-party Health Plan” means any person or entity, including a Carrier, that enters into
38	38	11a contract with a Provider Network Entity to gain access to the Provider Network Entity’s
39	39	12network of Participating Dental Providers whereby the cost of dental services furnished to 2 of 6
40	40	13subscribers and covered dependents are paid pursuant to the Third-party Health Plan’s own
41	41	14Dental Benefit Plan.
42	42	15 “Commissioner” means The Commissioner of Insurance.
43	43	16 “Carrier” means an insurer or other entity offering dental benefit plans in the
44	44	17Commonwealth.
45	45	18 “Participating Dental Provider” means a registered dentist, under an express written
46	46	19agreement with a Provider Network Entity, has agreed to perform Dental Service to subscribers
47	47	20and covered dependents, and to abide by the by-laws, rules and regulations of such Provider
48	48	21Network Entity, with an expectation of receiving payment, other than coinsurance, copayments
49	49	22or deductibles. For the purpose of Chapter 176Y, any notices or disclosures that Provider
50	50	23Network Entity and/or Third-party Health Plan are required to send to the Participating Dental
51	51	24Provider shall be addressed to the contracting party as specified in the written agreement
52	52	25between Participating Dental Provider and the Provider Network Entity.
53	53	26 “Dental Service” means the dental services ordinarily provided by registered dentists and
54	54	27dental practices in accordance with accepted practices in the community where the services are
55	55	28rendered.
56	56	29 “Dental Benefit Plan” means any dental plan that covers oral surgical care, dental
57	57	30services, dental procedures or benefits covered by any individual, general, blanket or group
58	58	31policy of health, accident and sickness insurance issued by an insurer licensed or otherwise
59	59	32authorized to transact accident and health insurance under chapter 175; any oral surgical care,
60	60	33dental services, dental procedures or benefits covered by a stand-alone individual or group dental
61	61	34medical service plan issued by a non-profit medical service corporation under chapter 176B; any 3 of 6
62	62	35oral surgical care, dental services, dental procedures or benefits covered by a stand-alone
63	63	36individual or group dental service plan issued by a dental service corporation under chapter
64	64	37176E; any oral surgical care, dental services, dental procedures or benefits covered by a stand-
65	65	38alone individual or group dental health maintenance contract issued by a health maintenance
66	66	39organization organized under chapter 176G; or any oral surgical care, dental services, dental
67	67	40procedures or benefits covered by a stand-alone individual or group preferred provider dental
68	68	41plan issued by a preferred provider arrangement organized under chapter 176I. The
69	69	42commissioner may, by regulation, define other dental coverage as a qualifying dental benefit
70	70	43plan for the purposes of this Section.
71	71	44 “Dental Network” means an arrangement of Participating Dental Providers, created
72	72	45and/or maintained by Provider Network Entity who have agreed to certain reimbursement for
73	73	46Dental Services provided to subscribers or their dependents.
74	74	47 ''Registered dentist'' means a dentist registered to practice dentistry in the commonwealth
75	75	48as provided in sections 45 and 48 of chapter 112 or a dentist registered in any other jurisdiction
76	76	49within the United States and its territories.
77	77	50 Section 2. Contractual Arrangement Transparency.
78	78	51 a. Notwithstanding any general or special law to the contrary, any Provider Network
79	79	52Entity that sells, rents, leases or grants access to its Participating Dental Providers or its Dental
80	80	53Network, directly or indirectly, to Third-Party Health Plans shall (i) have a signed written
81	81	54agreement with each Participating Dental Provider who participates in any of the Provider
82	82	55Network Entity’s Dental Networks and (ii) comply with the requirements of this Section. 4 of 6
83	83	56 b. At the time of initial contracting, the Provider Network Entity shall provide each
84	84	57Participating Dental Provider with (i) a list of the Third-Party Health Plans to which the Provider
85	85	58Network Entity has leased, rented or otherwise made it Dental Network accessible, and that the
86	86	59dentist will now be considered in-network for the Third-Party Health Plan’s Dental Network (ii)
87	87	60if signed agreement between Provider Network Entity and Participating Dental Provider includes
88	88	61multiple fee schedules, Provider Network Entity shall identify which fee schedule will be utilized
89	89	62by each Third-Party Health, (iii) applicable Third-party Health Plan’s credentialing practices and
90	90	63administrative policy and procedures; and (iv) any other material terms affecting the
91	91	64Participating Dental Provider’s participation in the Third-Party Provider Network Entity’s Dental
92	92	65Networks.
93	93	66 c. Third-party Health Plans shall reimburse Participating Dental Providers in
94	94	67accordance with the contracted fee schedule for the respective Dental Benefit Plan indicated in
95	95	68section 2(b)(ii). In the event the Third-Party Health Plan utilizes more than one Dental Network
96	96	69which could be a combination of proprietary and/or multiple Provider Network Entities Third-
97	97	70Party Health Plan shall provide written notice to each Participating Dental Provider identifying
98	98	71the specific Provider Network Entity contract being accessed for that Dental Benefit Plan and the
99	99	72notice must specify the applicable fee schedule that will be used for reimbursement for that
100	100	73specific Dental Benefit Plan. Third-party Health Plan shall also provide written notice to
101	101	74Participating Dental Provider identifying the specific Provider Network Entity and/or the
102	102	75prevailing fee schedule in advance to making any changes or updates.
103	103	76 d. In the event of a proposed change or amendment in the written agreement
104	104	77between the Provider Network entity and Participating Dental Provider, the Provider Network
105	105	78Entity shall reissue the notice requirements in section 2(b). 5 of 6
106	106	79 Section 3. Notification of Access to Provider Network
107	107	80 a. Each Third-party Health Plan shall, in clear and conspicuous language, notify its
108	108	81insured and administrative services only customers that the Third-party Health Plan is renting,
109	109	82leasing or otherwise making accessible, a network of providers from a Provider Network Entity.
110	110	83Annually, the Third-party Health Plan shall provide a report to its insured and administrative
111	111	84services only customers, including a total number of subscribers and their dependents that
112	112	85received Dental Services from each Provider Network entity. Third-party Health Plan is required
113	113	86to adopt and/or maintain consistent credentialing standards, utilization review and management
114	114	87processes, and quality of care practice or protocols (collectively, “Provider Quality Measures”)
115	115	88for all Dental Networks to which the Third-party Health Plan provides access, regardless of
116	116	89whether such Dental Networks are proprietary and internal to the operations of the Third-party
117	117	90Health Plan or through a Provider Network Entity. If the Third-party Health Plan does not adopt
118	118	91and maintain consistent Provider Quality Measures, the Third-party Health Plan shall notify its
119	119	92insured and administrative services only customers annually that it does not maintain consistent
120	120	93Provider Quality Measures and the differences in such Provider Quality Measures used for the
121	121	94Dental Networks.
122	122	95 b. Each Third-party Health Plan’s provider directory shall indicate the listed
123	123	96providers are part of a leased, rented or made otherwise accessible, through a contractual
124	124	97arrangement with the Provider Network Entity and that Third-party Health Plan does not have a
125	125	98direct contract with such Participating Dental Provider. Each Third-party Health Plan shall
126	126	99notify its subscribers and their dependents annually that any disputes or disagreement that arise
127	127	100between a subscriber or their dependents and the Participating Dental Provider shall be resolved 6 of 6
128	128	101according to the terms of the direct written agreement between the Participating Dental Provider
129	129	102and the Provider Network Entity.
130	130	103 c. Annually, but no later than Nov 15, each Provider Network Entity shall provide
131	131	104each Participating Dental Provider the notice requirements in section 2(b). The notice shall
132	132	105include, in addition to the list of Third-party Health Plans that utilize the Participating Dental
133	133	106Provider, the volume of patients seen through each Third-party Health Plan.
134	134	107 Section 4. Commissioner’s approval. Third-Party Health Plan that is renting, leasing or
135	135	108otherwise accessing a Dental Network under this Section shall at all times be subject to a public
136	136	109hearing as provided by section two of chapter 30A and receive prior written approval from the
137	137	110Commissioner. No such arrangement shall be approved if the Commissioner finds the use of
138	138	111such Dental Network by a Dental Benefit Plan or by the Third-Party Health Plan is unreasonable
139	139	112in relation to (i) the median fee schedule reimbursement from all Dental Benefit Plans offering
140	140	113by Carriers, (ii) the premium charged for such services, and (iii) if the premium charge are
141	141	114excessive, inadequate or unfairly discriminatory.