25.1361.01000
Sixty-ninth
Legislative Assembly
of North Dakota
Introduced by
Senators Castaneda, Bekkedahl, Lee, Barta
Representatives Vigesaa, Ostlie
A BILL for an Act to create and enact a new section to chapter 26.1-36.9 of the North Dakota
Century Code, relating to joint negotiations by dental providers with dental insurers; and to
provide a penalty.
BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
SECTION 1. A new section to chapter 26.1-36.9 of the North Dakota Century Code is
created and enacted as follows:
Joint negotiations by dental providers with dental insurers.
1.As authorized under this section, two or more dental providers practicing in the service
area of a dental insurer may jointly negotiate with the dental insurer and engage in
related joint activity regarding non-fee-related matters including:
a.Definition of medical necessity and other conditions of coverage.
b.Utilization management criteria and procedures.
c.Clinical practice guidelines.
d.Preventative care and other medical management policies.
e.Patient referral standards and procedures.
f.Drug formularies and standards for prescribing off-formulary drugs.
g.Quality assurance programs.
h.Liability terms for a dental provider and dental insurer.
i.Methods and timing of payments.
j.Administrative procedures.
k.Credentialing standards and procedures for selection, retention, and termination
of participating dentists.
l.Mechanisms for resolving disputes between the dental insurer and dental
provider.
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m.Dental benefits sold or administered by the dental insurer in which the dental
provider is required to participate.
n.Formulation and application of reimbursement methodology.
o.Inclusion or alteration of a contractual term or condition, except when the
inclusion or alteration is otherwise required by federal or state law.
2.As authorized under this section, upon a finding by the commissioner that a dental
insurer has substantial market power in a service area and any of the terms or
conditions of the contract with the dental insurer pose an actual or potential threat to
the quality and availability of patient care among covered individuals, two or more
independent dental providers may jointly negotiate with the dental insurer and engage
in related joint activity relating to fees and fee-related matters, including the:
a.Amount of payment.
b.Amount of discount.
c.Procedure codes or descriptions of services covered by payment.
d.Appropriate grouping of procedure codes.
3.a.The dental providers may communicate with each other and a joint negotiation
representative authorized to negotiate on behalf of the dental providers with the
dental insurer concerning any contractual term or condition to be negotiated. For
purposes of this section, a "joint negotiation representative" means a
representative selected by two or more independent dental providers to engage
in joint negotiations with a dental insurer on behalf of the dental providers.
b.The joint negotiation representative is the only party authorized to negotiate with
the dental insurer on behalf of the dental providers as a group.
c.The dental providers may agree to be bound by the terms and conditions
negotiated by the joint negotiation representative.
4.A person may not act as a joint negotiation representative without express permission
from the commissioner.
5.Upon the joint negotiation representative and dental insurer determining an agreement
has been reached on contractual terms or conditions that will be the subject matter of
the negotiations, the joint negotiation representative shall submit to the commissioner,
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for approval, a copy of the proposed contract between the dental providers and dental
insurer.
a.Within thirty days of receipt of the proposed contract, the commissioner shall
review the proposed contract and provide a determination. If the commissioner
disapproves the contract, the commissioner shall communicate to the joint
negotiation representative any deficiencies and specific remedial measures for
the deficiencies.
b.Upon approval of the proposed contract, the dental providers, through the joint
negotiation representative, and the dental insurer may engage in negotiations.
c.The joint negotiation representative shall submit the negotiated contract to the
commissioner for review.
6.A negotiated contract and any plan of action for implementing a negotiated contract
must be approved by the commissioner before becoming effective. Within thirty days
of receipt of the negotiated contract, the commissioner shall review the proposed
contract and provide a determination. If the commissioner disapproves the contract,
the commissioner shall communicate to the joint negotiation representative any
deficiencies and specific remedial measures for the deficiencies.
7.The commissioner shall adopt rules and procedures as necessary to carry out the
responsibilities of this section.
8.This section does not apply to dental benefit plans providing covered services
exclusively or primarily to individuals who are eligible for medical assistance.
9.Any negotiations under this section must be made in good faith. A person that does
not negotiate in good faith may be subject to sanctions or penalties as determined by
the commissioner.
10.This section may not be construed to:
a.Permit a coordinated cessation reduction or limitation of dental services.
b.Affect governmental approval of, or otherwise restrict activity by, dental providers
which is not prohibited under federal antitrust law or require approval of contract
terms to the extent the terms are exempt from state regulation under federal law.
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