Oklahoma 2023 Regular Session

Oklahoma House Bill HB1694 Compare Versions

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Version 2 (New)

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3		-	ENGR. H. B. NO. 1694 Page 1 1
	3	+	HB1694 HFLR Page 1
	4	+	BOLD FACE denotes Committee Amendments. 1
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28		-	ENGROSSED HOUSE
29		-	BILL NO. 1694 By: McEntire of the House
	29	+	HOUSE OF REPRESENTATIVES - FLOOR VERSION
	30	+
	31	+	STATE OF OKLAHOMA
	32	+
	33	+	1st Session of the 59th Legislature (2023)
	34	+
	35	+	COMMITTEE SUBSTITUTE
	36	+	FOR
	37	+	HOUSE BILL NO. 1694 By: McEntire of the House
30	38
31	39		and
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33	41		Montgomery of the Senate
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	47	+	COMMITTEE SUBSTITUTE
39	48
40	49		An Act relating to dental insurance; providing
41	50		definition; providing how a medic al loss ratio is
42	51		calculated; requiring certain hea lth care service
43	52		plans to file a medical loss ratio report; providing
44	53		exemptions; verifying medical loss ratio annual
45	54		report; requiring certain health care service plans
46	55		to provide annual rebates ; requiring the Oklahoma
47	56		Insurance Department to regulate rates; authorizing
48	57		the Attorney General to intervene ; providing for
49	58		codification; and providing an effective date.
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54	63		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
55	64		SECTION 1. NEW LAW A new section of law to be codified
56	65		in the Oklahoma Statutes as Section 7350 of Title 36, unless there
57	66		is created a duplication in numbering, reads as follows:
58	67		A. As used in this act, "medical loss ratio (MLR) " means the
59	68		minimum percentage of all premium funds collected by an insurer e ach
60	69		year that must be spent on actual patient care rather than overhead
61		-	costs. The minimum required percentage that dental insurance plan s
62		-	must meet for the portion of patient premiums must be dedicated to
63		-	patient care rather than administrative and overh ead costs or the
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65		-	ENGR. H. B. NO. 1694 Page 2 1
	71	+	HB1694 HFLR Page 2
	72	+	BOLD FACE denotes Committee Amendments. 1
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	97	+	costs. The minimum required percentage that dental insurance plan s
	98	+	must meet for the portion of patient premiums must be dedicated to
	99	+	patient care rather than administrative and overh ead costs or the
90	100		difference must be refunded to individuals and groups in the form of
91	101		a rebate.
92	102		Medical loss ratio for a dental plan or de ntal coverage of a
93	103		health benefit plan shall be determined by dividing th e numerator by
94	104		the denominator as defined below:
95	105		1. The numerator shall be the amount spent on care. The amount
96	106		spent on care shall include:
97	107		a. the amount expended for clinical dent al services which
98	108		are services within the code on dental procedures and
99	109		nomenclature, provided to enrollees which includes
100	110		payments under capitation contracts with dental
101	111		providers, whose services are covered by the contr act
102	112		for dental clinical services or supplies covered by
103	113		the contract,
104	114		b. unpaid claim reserves means reserves and liabilities
105	115		established to account for claims that were incurred
106	116		during the MLR reporting year but were not paid within
107	117		three (3) months of the end of the MLR reporting year,
108	118		c. any overpayment that has already been received from
109	119		providers should not be reported as a paid claim.
110		-	Overpayment recoveries re ceived from providers must be
111		-	deducted from incurred claims amounts , and
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113		-	ENGR. H. B. NO. 1694 Page 3 1
	121	+	HB1694 HFLR Page 3
	122	+	BOLD FACE denotes Committee Amendments. 1
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	147	+	Overpayment recoveries re ceived from providers must be
	148	+	deducted from incurred claims amounts , and
138	149		d. any claim payment recovered by insurers fro m providers
139	150		or enrollees using utilization management efforts, but
140	151		be deducted from incurred claims amounts.
141	152		2. The calculation of the numerator does not include:
142	153		a. all administrative costs including , but not limited
143	154		to, infrastructure, personnel costs, or broker
144	155		payments,
145	156		b. amounts paid to third-party vendors for secondary
146	157		network savings,
147	158		c. amounts paid to third-party vendors for network
148	159		development, administrative fees, claims processing,
149	160		and utilization management, or
150		-	d. amounts paid to providers for professional or
	161	+	d. amounts paid to a providers for professional or
151	162		administrative services that do not represent
152	163		compensation or reimbursement for covered services
153	164		provided to an enrollee, including, but not limited
154	165		to, dental record copying costs, atto rney fees,
155	166		subrogation vendor fees, compensation t o
156	167		paraprofessionals, janitors, quality assurance
157	168		analysts, administrative supervi sors, secretaries to
158	169		dental personnel, and dental record clerks.
159		-	3. The denominator is calculated using insurer reven ue:
160		-	a. earned premium means all monies paid by a policyho lder
161		-	or subscriber as a condition of receiving coverage
	170	+	3. The denominator is calculated using insurer reven ue.
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163		-	ENGR. H. B. NO. 1694 Page 4 1
	172	+	HB1694 HFLR Page 4
	173	+	BOLD FACE denotes Committee Amendments. 1
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	198	+	a. earned premium means all monies paid by a policyho lder
	199	+	or subscriber as a condition of receiving coverage
188	200		from the issuer, includin g any fees or other
189	201		contributions associated wit h the dental plan, and
190	202		b. the denominator is the to tal amount of the earned
191	203		premium revenues, excluding federal and state taxes
192	204		and licensing and regulatory fees paid after
193	205		accounting for any payments pursuan t to federal law.
194	206		B. A dental benefit plan or the dental por tion of a health
195	207		benefit plan that issues, sells, renews, or offers a specialized
196	208		health benefit plan contract covering dental services shall file a
197	209		medical loss ratio (MLR) with the Oklahoma Insurance Department that
198	210		is organized by market and product typ e and, where appropriate,
199	211		contains the same informat ion required in the 2013 federal Medical
200	212		Loss Ratio Annual Reporting Form (CMS-10418).
201	213		C. The MLR reporting year shall be for the calendar year during
202	214		which dental coverage is provided by the plan. All terms used in
203	215		the MLR annual report shall have the s ame meaning as used in the
204	216		federal Public Health Service Act , 42 U.S.C., Section 300gg-18, Part
205	217		158 of Title 45 of the Code of Federal Regulations.
206	218		D. If data verification of the dental benefit plan or the
207	219		dental portion of a health benefit plan's representations in the MLR
208	220		annual report is deemed necessary, the Department shall provide the
209		-	health benefit plan with a notification thirty (30) days before the
210		-	commencement of the financial examination.
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212		-	ENGR. H. B. NO. 1694 Page 5 1
	222	+	HB1694 HFLR Page 5
	223	+	BOLD FACE denotes Committee Amendments. 1
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	248	+	health benefit plan with a notification thirty (30) days before the
	249	+	commencement of the financial examination.
237	250		E. The dental benefit plan or the dental portion of a health
238	251		benefit plan shall have thirty (30) days from the date of
239	252		notification to submit to the Department all requested data. The
240	253		Insurance Commissioner may extend the time for a health benefit plan
241	254		to comply with this sub section upon a finding of good cause.
242	255		F. The Department shall make available to the public all of the
243	256		data provided to the Department pursuant to this section.
244	257		G. Exempt from this act are health benefit plans for health
245	258		care services under Medicaid, the Children's Health Insurance
246	259		Program, or other state-sponsored health programs.
247	260		SECTION 2. NEW LAW A new section of law to be codified
248	261		in the Oklahoma Stat utes as Section 7351 of Title 36, unless there
249	262		is created a duplication in numbering, reads as follows:
250	263		A. A dental benefit plan or the dental portion of a health
251	264		benefit plan that issues, sells, renews, or offers a specialized
252	265		health care service plan contract covering dental services shall
253	266		provide an annual rebate to each enrollee under that cov erage, on a
254	267		pro rata basis, if t he ratio of the amount of premium revenue
255	268		expended by the dental benefit plan or the dental portion of a
256	269		health benefit plan on the costs for reimbursement for services
257	270		provided to enrollees under that coverage and for activities that
258	271		improve dental care quality to the total amount of premium revenue,
259		-	excluding federal and state taxes and licensing or regulatory fees,
260		-	and after accounting for payments or receipts for risk adjustment,
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262		-	ENGR. H. B. NO. 1694 Page 6 1
	273	+	HB1694 HFLR Page 6
	274	+	BOLD FACE denotes Committee Amendments. 1
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	299	+	excluding federal and state taxes and licensing or regulatory fees,
	300	+	and after accounting for payments or receipts for risk adjustment,
287	301		risk corridors, and reinsurance, as reported in subsection B of
288	302		Section 1 of this act, is less than, at minimum, eighty percent
289	303		(80%).
290	304		B. The total amount of an annual rebate required under this
291	305		section shall be calculated in an amount equal to the product of the
292	306		amount by which the percentage described in subsection A of this
293	307		section exceeds the insurer's reported ratio described in subsection
294	308		B of Section 1 of this act multiplied by the total amoun t of premium
295	309		revenue, excluding federal and state taxes and licensing or
296	310		regulatory fees and after accounting for payments or receipts for
297	311		risk adjustment, risk corridors, and r einsurance.
298	312		C. A dental benefit plan or the dental portion of a health
299	313		benefit plan shall provide any rebate owing to an enrollee no later
300	314		than August 1 of the calendar year following the year for which the
301	315		ratio described in sub section A of this section was calculated.
302	316		SECTION 3. NEW LAW A new section of la w to be codified
303	317		in the Oklahoma Statutes as Secti on 7352 of Title 36, unless there
304	318		is created a duplication in numbering, reads as follows:
305	319		A. All carriers offering dental benefit plans shall file group
306	320		product base rates and any changes to group rating factors that are
307	321		to be effective on January 1 of each year, on or before July 1 of
308	322		the preceding year. The Oklahoma Insurance Depart ment shall
309		-	disapprove any proposed changes t o base rates that are excessive,
310		-	inadequate, or unreasonable in relation to the benefits charged.
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312		-	ENGR. H. B. NO. 1694 Page 7 1
	324	+	HB1694 HFLR Page 7
	325	+	BOLD FACE denotes Committee Amendments. 1
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	350	+	disapprove any proposed changes t o base rates that are excessive,
	351	+	inadequate, or unreasonable in relation to the benefits charged.
337	352		The Department shall disapprove any change to group rating factors
338	353		that is discriminatory or not actuarially sound.
339	354		B. The carrier's rate shall be presumptively disapproved by the
340	355		Department if:
341	356		1. A carrier files a base rate change a nd the administrative
342	357		expense loading component, not including taxes and assessments,
343	358		increases by more than the most recent calendar year 's percentage
344	359		increase in the dental services Consumer Price Index for All Urban
345	360		Consumers, U.S. city average, not seasonally adjusted;
346	361		2. A carrier's reported contribution to surplus exceeds one and
347	362		nine-tenths percent (1.9%); or
348	363		3. The aggregate medical loss ratio fo r all plans offered by a
349	364		carrier is less than the applicable percentage set forth in
350	365		subsection A of Section 2 of this act.
351	366		C. If a proposed rate change has been presumptively
352	367		disapproved:
353	368		1. A carrier shall communicate to all employers and individuals
354	369		covered under a group product that the proposed increase has been
355	370		presumptively disapproved and is subje ct to a hearing by the
356	371		Department;
357		-	2. The Department shall conduct a public hearing and shall
358		-	properly advertise the hearing in compliance with public h earing
359		-	requirements; and
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361		-	ENGR. H. B. NO. 1694 Page 8 1
	373	+	HB1694 HFLR Page 8
	374	+	BOLD FACE denotes Committee Amendments. 1
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	399	+	2. The Department shall conduct a public hearing and shall
	400	+	properly advertise the hearing in compliance with public h earing
	401	+	requirements; and
386	402		3. The Attorney General may intervene in a public hearing or
387	403		other proceeding under this section and may require addition al
388	404		information as the Attorney General considers necessa ry to ensure
389	405		compliance with this subsection.
390	406		D. If the Department disapproves the rate submitted by a
391	407		carrier, the Department shall notify the carrier in writing no later
392	408		than forty-five (45) days prior to the proposed effective date of
393	409		the carrier's rate. The carrier may submit a request for hearing to
394	410		the Department within ten (10) days of such notice of disapproval.
395	411		The Department must schedule a hearing within fifteen (15) days upon
396	412		receipt of the request for hearing. The Department shall issue a
397	413		written decision within thirty (30) days after the conclusion of the
398	414		hearing. The carrier may not implement the disapproved rates or
399	415		changes at any time unl ess the Department reverses the disapproval
400	416		after a hearing or unless a c ourt vacates the Department's decision.
401	417		SECTION 4. This act shall become effec tive November 1, 2023.
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428		-	Passed the House of Representatives the 14th day of March, 2023.
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433		-	Presiding Officer of the House
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435		-	of Representatives
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438		-	Passed the Senate the ____ day of __________, 2023.
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443		-	Presiding Officer of the Senate
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	419	+	COMMITTEE REPORT BY: COMMITTEE ON INSURANCE, dated 03/01/2023 - DO
	420	+	PASS, As Amended and Coauthored.