HB3023 HFLR Page 1
BOLD FACE denotes Committee Amendments. 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
HOUSE OF REPRESENTATIVES - FLOOR VERSION
STATE OF OKLAHOMA
2nd Session of the 58th Legislature (2022)
COMMITTEE SUBSTITUTE
FOR
HOUSE BILL NO. 3023 By: Worthen
COMMITTEE SUBSTITUTE
An Act relating to dental insurance claims; amending
36 O.S. 2021, Section 7301, which relates to dental
plans; modifying definition ; defining terms; making
certain requirements; providing standards for
requirements; providing for codification; and
providing an effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2021, Section 7301, is
amended to read as follows :
Section 7301. A. No contract between a dental plan of a health
benefit plan and a dentis t for the provision of services to patients
may require that a dentist provide services to its subscribers at a
fee set by the health benefit plan unless the services are covered
services under the applicable subscriber agreement.
B. As used in this secti on:
1. "Covered services" means services reimbursable reimbursed
under the applicable subscriber agreement, subject notwithstanding,
HB3023 HFLR Page 2
BOLD FACE denotes Committee Amendments. 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
or without regard to the contractual limitations on subscriber
benefits as may apply , including, for example, deductibles, waiting
period or frequency limitations ;
2. "Dental plan" means and shall include any policy of
insurance which is issued by a health benefit plan which provides
for coverage of dental services not in connection with a medical
plan; and
3. "Health benefit plan" me ans any plan or arrangement as
defined in subsection C of Section 6060.4 of this title or any
dental service corporation authorized pursuant to Section 267 1 of
this title.
C. A health benefit plan or dental plan shall establish and
maintain appeal procedu res for any claim by a dentist or a
subscriber that is denied based on lack of medical necessity. Any
such denial shall be based upon a determination by a dentist who
holds a nonrestricted license in the United States. Any written
communication to a dent ist that includes or pertains to a de nial of
benefits for all or part of a claim on the basis of a lack of
medical necessity shall include the identifier a nd license number
together with state of issuance, and a contact telephone number of
the licensed dentist making the adverse determination . The dentist
who reviewed the claim shall only be contacted at the telephone
number provided in the written communic ation about the denial during
business hours.
HB3023 HFLR Page 3
BOLD FACE denotes Committee Amendments. 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 7301.1 of Title 36, unless there
is created a duplication in num bering, reads as follows:
A. As used in this section :
1. "Bundling" means the practice of combining disti nct dental
procedures into one procedure for billing purposes;
2. "Dental plan" means and shall include any policy of
insurance which is issued by a health benefit plan which provides
for coverage of dental services not in connection with a medical
plan;
3. "Downcoding" means the adjustment of a cl aim submitted to a
dental plan to a less complex or lower cost procedure code;
4. "Health benefit plan " means any plan or arrangement as
defined in subsection C of Section 6060.4 of Title 36 of the
Oklahoma Statutes or any dental service corporation autho rized
pursuant to Section 2671 of Title 36 of the Oklahoma Statutes; and
5. "Material change" means a change to the following:
a. a dental plan's rules, guidelines, policies, or
procedures concerning payment for de ntal services,
b. the general practices of the dental pla n that affect
reimbursements paid to providers, or
c. how a dental plan adjudicate s and pays claims for
services.
HB3023 HFLR Page 4
BOLD FACE denotes Committee Amendments. 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
B. An insurer that contracts or renews a contract with a dental
provider shall:
1. Make the insurer's current dental plan policies av ailable
online; and
2. If requested by a provider, send a copy o f the policies to
the provider through mail or electronic mail.
C. Dental policies and plans as described in subsection B of
this section shall provide the following to providers:
1. A summary of all material changes made to a dental plan
since the policies were last updated;
2. The downcoding and bundling policies that the insurer
reasonably expects to be applied to the dental provider or
provider's services as a matter of pol icy; and
3. A description of the dental plan's utilization review
procedures, including:
a. a procedure for an enrollee of the dental plan to
obtain a review of an adverse determination, and
b. a statement of a provider 's rights and
responsibilities reg arding the procedures described in
subparagraph a of this paragraph.
D. An insurer may not maintain a dental plan that:
1. Based on the provider's contracted fee for covered
services, uses downcoding in a manner tha t prevents a dental
HB3023 HFLR Page 5
BOLD FACE denotes Committee Amendments. 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
provider from collecting the fee for actu al services performed
either from the plan or the patient; or
2. Uses bundling in a manner where a procedure code is labeled
as nonbillable to the pati ent unless, under generally accepted
practice standards, the procedure code is for a procedure that m ay
be provided in conjunction with another procedure .
E. An insurer shall ensure that an explanation of benefits for
a dental plan includes the reason for any downcoding or bundling
result.
SECTION 3. This act shall become effective November 1, 2022.
COMMITTEE REPORT BY: COMMITTEE ON INSURANCE, dated 02/17/2022 - DO
PASS, As Amended.