EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
FIRST REGULAR SESSION
SENATE BILL NO. 527
102ND GENERAL ASSEMBLY
INTRODUCED BY SENATOR GANNON.
1767S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal section 376.1060, RSMo, and to enact in lieu thereof one new section relating to the
delivery of health care services by dentists.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Section 376.1060, RSMo, is repealed and one 1
new section enacted in lieu thereof, to be known as section 2
376.1060, to read as follows:3
376.1060. 1. As used in this section, the following 1
terms shall mean: 2
(1) "Contracting entity", any person or entity , 3
including a health carrier, that is engaged in the act of 4
contracting with providers for the delivery of [dental] 5
health care services [or the selling or assigning of dental 6
network plans to other health care entities ]; 7
(2) ["Identify", providing in writing, by email or 8
otherwise, to the participating provider the name, address, 9
and telephone number, to the extent pos sible, for any third 10
party to which the contracting entity has granted access to 11
the health care services of the participating provider ] 12
"Health care service", the same meaning given to the term in 13
section 376.1350; 14
(3) "Health carrier", the same meaning given to the 15
term in section 376.1350. The term "health carrier" shall 16
also include any entity described in subdivision (4) of 17
section 354.700; 18 SB 527 2
(4) "Network plan", [health insurance] coverage 19
offered by a health [insurance issuer] carrier for health 20
care services provided by a participating provider under 21
which the financing and delivery of [dental] the health care 22
services are provided in whole or in part through a defined 23
set of participating providers [under contract with the 24
health insurance issuer ]; 25
[(4)] (5) "Participating provider", a provider who, 26
under a contract with a contracting entity, has agreed to 27
provide [dental] health care services with an expectation of 28
receiving payment, other than coinsurance, co -payments or 29
deductibles, directly or indirectly from the contracting 30
entity; 31
[(5)] (6) "Provider", any person licensed under 32
section 332.071. 33
2. A contracting entity shall not sell, assign, or 34
otherwise grant a network plan access to [the dental 35
services of] a participating [provider under a health care 36
contract unless expressly authorized by the health care 37
contract. The health care contract shall specifically 38
provide that one purpose of the contract is the selling, 39
assigning, or giving the contracting entity rights to the 40
services of the participating provider, including network 41
plans] provider's health care services until the contracting 42
entity has notified the participating provider thirty days 43
in advance of such participating provider 's health care 44
services being made available to the network plan's 45
participants and the participating provider has agreed in 46
writing separate from any other agreement entered into 47
before the receipt of the notification. The notification 48
shall identify the network plan, the health care services 49
included, and a fee schedule if different from the network 50 SB 527 3
plan for which the participating provider is currently 51
providing health care services . 52
3. [Upon entering a contract with a participating 53
provider and upon request by a participating provider, a 54
contracting entity shall properly identify any third party 55
that has been granted access to the dental services of the 56
participating provider. 57
4.] A contracting entity that sells, assigns, or 58
otherwise grants a network plan access to [the dental 59
services of] a participating [provider] provider's health 60
care services shall maintain an internet website or a toll - 61
free telephone number through which the participating 62
provider may obtain informatio n which identifies the 63
[insurance] health carrier to be used to reimburse the 64
participating provider for the covered [dental] health care 65
services. 66
[5.] 4. A contracting entity that sells, assigns, or 67
otherwise grants a network plan access to a participating 68
provider's [dental] health care services shall ensure that 69
an explanation of benefits or remittance advice furnished to 70
the participating provider that delivers [dental] health 71
care services [under the health care contract ] for the 72
network plan identifies the contractual source of any 73
applicable discount. 74
[6. All third parties that have contracted with a 75
contracting entity to purchase, be assigned, or otherwise be 76
granted access to the participating provider's discounted 77
rate shall comply with the participating provider's 78
contract, including all requirements to encourage access to 79
the participating provider, and pay the participating 80
provider pursuant to the rates of payment and methodology 81 SB 527 4
set forth in that contract, unless o therwise agreed to by a 82
participating provider. 83
7. A contracting entity is deemed in compliance with 84
this section when the insured's identification card provides 85
information which identifies the insurance carrier to be 86
used to reimburse the parti cipating provider for the covered 87
dental services.] 88