Oklahoma 2022 Regular Session

Oklahoma House Bill HB3023 Compare Versions

Version 1 (Old)

Version 2 (New)

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3		-	HB3023 HFLR Page 1
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29		-	HOUSE OF REPRESENTATIVES - FLOOR VERSION
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31	28		STATE OF OKLAHOMA
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33	30		2nd Session of the 58th Legislature (2022)
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35	32		COMMITTEE SUBSTITUTE
36	33		FOR
37	34		HOUSE BILL NO. 3023 By: Worthen
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43	40		COMMITTEE SUBSTITUTE
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45	42		An Act relating to dental insurance claims; amending
46	43		36 O.S. 2021, Section 7301, which relates to dental
47	44		plans; modifying definition ; defining terms; making
48	45		certain requirements; providing standards for
49	46		requirements; providing for codification; and
50	47		providing an effective date.
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55	52		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLA HOMA:
56	53		SECTION 1. AMENDATORY 36 O.S. 2021, Section 7301, is
57	54		amended to read as follows :
58	55		Section 7301. A. No contract between a dental plan of a health
59	56		benefit plan and a dentis t for the provision of services to patients
60	57		may require that a dentist provide services to its subscribers at a
61	58		fee set by the health benefit plan unless the services are covered
62	59		services under the applicable subscriber agreement.
63	60		B. As used in this secti on:
64	61		1. "Covered services" means services reimbursable reimbursed
65	62		under the applicable subscriber agreement, subject notwithstanding,
	63	+	or without regard to the contractual limitations on subscriber
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67		-	HB3023 HFLR Page 2
68		-	BOLD FACE denotes Committee Amendments. 1
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93		-	or without regard to the contractual limitations on subscriber
94	90		benefits as may apply , including, for example, deductibles, waiting
95	91		period or frequency limitations ;
96	92		2. "Dental plan" means and shall include any policy of
97	93		insurance which is issued by a health benefit plan which provides
98	94		for coverage of dental services not in connection with a medical
99	95		plan; and
100	96		3. "Health benefit plan" me ans any plan or arrangement as
101	97		defined in subsection C of Section 6060.4 of this title or any
102	98		dental service corporation authorized pursuant to Section 267 1 of
103	99		this title.
104	100		C. A health benefit plan or dental plan shall establish and
105	101		maintain appeal procedu res for any claim by a dentist or a
106	102		subscriber that is denied based on lack of medical necessity. Any
107	103		such denial shall be based upon a determination by a dentist who
108	104		holds a nonrestricted license in the United States. Any written
109	105		communication to a dent ist that includes or pertains to a denial of
110	106		benefits for all or part of a claim on the basis of a lack of
111	107		medical necessity shall include the identifier a nd license number
112	108		together with state of issuance, and a contact telephone number of
113	109		the licensed dentist making the adverse determination. The dentist
114	110		who reviewed the claim shall only be contacted at the telephone
115	111		number provided in the written communic ation about the denial during
116	112		business hours.
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118		-	HB3023 HFLR Page 3
119		-	BOLD FACE denotes Committee Amendments. 1
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144	139		SECTION 2. NEW LAW A new section of law to be codified
145	140		in the Oklahoma Stat utes as Section 7301.1 of Title 36, unless there
146	141		is created a duplication in num bering, reads as follows:
147	142		A. As used in this section :
148	143		1. "Bundling" means the practice of combining disti nct dental
149	144		procedures into one procedure for billing purposes;
150	145		2. "Dental plan" means and shall include any policy of
151	146		insurance which is issued by a health benefit plan which provides
152	147		for coverage of dental services not in connection with a medical
153	148		plan;
154	149		3. "Downcoding" means the adjustment of a cl aim submitted to a
155	150		dental plan to a less complex or lower cost procedure code;
156	151		4. "Health benefit plan " means any plan or arrangement as
157	152		defined in subsection C of Section 6060.4 of Title 36 of the
158	153		Oklahoma Statutes or any dental service corporation autho rized
159	154		pursuant to Section 2671 of Title 36 of the Oklahoma Statutes; and
160	155		5. "Material change" means a change to the following:
161	156		a. a dental plan's rules, guidelines, policies, or
162	157		procedures concerning payment for de ntal services,
163	158		b. the general practices of the dental plan that affect
164	159		reimbursements paid to providers, or
165	160		c. how a dental plan adjudicate s and pays claims for
166	161		services.
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168		-	HB3023 HFLR Page 4
169		-	BOLD FACE denotes Committee Amendments. 1
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194	188		B. An insurer that contracts or renews a contract with a dental
195	189		provider shall:
196	190		1. Make the insurer's current dental plan policies av ailable
197	191		online; and
198	192		2. If requested by a provider, send a copy o f the policies to
199	193		the provider through mail or electronic mail.
200	194		C. Dental policies and plans as described in subsection B of
201	195		this section shall provide the following to providers:
202	196		1. A summary of all material changes made to a dental plan
203	197		since the policies were last updated;
204	198		2. The downcoding and bundling policies that the insurer
205	199		reasonably expects to be applied to the dental provider or
206	200		provider's services as a matter of pol icy; and
207	201		3. A description of the dental plan's utilization review
208	202		procedures, including:
209	203		a. a procedure for an enrollee of the dental plan to
210	204		obtain a review of an adverse determination, and
211	205		b. a statement of a provider 's rights and
212	206		responsibilities reg arding the procedures described in
213	207		subparagraph a of this paragraph.
214	208		D. An insurer may not maintain a dental plan that:
215	209		1. Based on the provider's contracted fee for covered
216	210		services, uses downcoding in a manner tha t prevents a dental
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218		-	HB3023 HFLR Page 5
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244	237		provider from collecting the fee for actual serv ices performed
245	238		either from the plan or the patient; or
246	239		2. Uses bundling in a manner where a procedure code is labeled
247	240		as nonbillable to the pati ent unless, under generally accepted
248	241		practice standards, the procedure code is for a procedure that m ay
249	242		be provided in conjunction with another procedure .
250	243		E. An insurer shall ensure that an explanation of benefits for
251	244		a dental plan includes the reason for any downcoding or bundling
252	245		result.
253	246		SECTION 3. This act shall become effective November 1, 2022.
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255		-	COMMITTEE REPORT BY: COMMITTEE ON INSURANCE, dated 02/17/2022 - DO
256		-	PASS, As Amended.
	248	+	58-2-10645 MJ 02/17/22
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