Oklahoma 2024 Regular Session

Oklahoma House Bill HB1694 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
3		-	ENGR. H. B. NO. 1694 Page 1 1
	3	+	HB1694 HFLR Page 1
	4	+	BOLD FACE denotes Committee Amendments. 1
4	5		2
5	6		3
6	7		4
7	8		5
8	9		6
9	10		7
10	11		8
11	12		9
12	13		10
13	14		11
14	15		12
15	16		13
16	17		14
17	18		15
18	19		16
19	20		17
20	21		18
21	22		19
22	23		20
23	24		21
24	25		22
25	26		23
26	27		24
27	28
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
32	40
33	41		Montgomery of the Senate
34	42
35	43
36	44
37	45
38	46
	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.
50	59
51	60
52	61
53	62
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
64	70
65		-	ENGR. H. B. NO. 1694 Page 2 1
	71	+	HB1694 HFLR Page 2
	72	+	BOLD FACE denotes Committee Amendments. 1
66	73		2
67	74		3
68	75		4
69	76		5
70	77		6
71	78		7
72	79		8
73	80		9
74	81		10
75	82		11
76	83		12
77	84		13
78	85		14
79	86		15
80	87		16
81	88		17
82	89		18
83	90		19
84	91		20
85	92		21
86	93		22
87	94		23
88	95		24
89	96
	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
112	120
113		-	ENGR. H. B. NO. 1694 Page 3 1
	121	+	HB1694 HFLR Page 3
	122	+	BOLD FACE denotes Committee Amendments. 1
114	123		2
115	124		3
116	125		4
117	126		5
118	127		6
119	128		7
120	129		8
121	130		9
122	131		10
123	132		11
124	133		12
125	134		13
126	135		14
127	136		15
128	137		16
129	138		17
130	139		18
131	140		19
132	141		20
133	142		21
134	143		22
135	144		23
136	145		24
137	146
	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.
162	171
163		-	ENGR. H. B. NO. 1694 Page 4 1
	172	+	HB1694 HFLR Page 4
	173	+	BOLD FACE denotes Committee Amendments. 1
164	174		2
165	175		3
166	176		4
167	177		5
168	178		6
169	179		7
170	180		8
171	181		9
172	182		10
173	183		11
174	184		12
175	185		13
176	186		14
177	187		15
178	188		16
179	189		17
180	190		18
181	191		19
182	192		20
183	193		21
184	194		22
185	195		23
186	196		24
187	197
	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.
211	221
212		-	ENGR. H. B. NO. 1694 Page 5 1
	222	+	HB1694 HFLR Page 5
	223	+	BOLD FACE denotes Committee Amendments. 1
213	224		2
214	225		3
215	226		4
216	227		5
217	228		6
218	229		7
219	230		8
220	231		9
221	232		10
222	233		11
223	234		12
224	235		13
225	236		14
226	237		15
227	238		16
228	239		17
229	240		18
230	241		19
231	242		20
232	243		21
233	244		22
234	245		23
235	246		24
236	247
	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,
261	272
262		-	ENGR. H. B. NO. 1694 Page 6 1
	273	+	HB1694 HFLR Page 6
	274	+	BOLD FACE denotes Committee Amendments. 1
263	275		2
264	276		3
265	277		4
266	278		5
267	279		6
268	280		7
269	281		8
270	282		9
271	283		10
272	284		11
273	285		12
274	286		13
275	287		14
276	288		15
277	289		16
278	290		17
279	291		18
280	292		19
281	293		20
282	294		21
283	295		22
284	296		23
285	297		24
286	298
	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.
311	323
312		-	ENGR. H. B. NO. 1694 Page 7 1
	324	+	HB1694 HFLR Page 7
	325	+	BOLD FACE denotes Committee Amendments. 1
313	326		2
314	327		3
315	328		4
316	329		5
317	330		6
318	331		7
319	332		8
320	333		9
321	334		10
322	335		11
323	336		12
324	337		13
325	338		14
326	339		15
327	340		16
328	341		17
329	342		18
330	343		19
331	344		20
332	345		21
333	346		22
334	347		23
335	348		24
336	349
	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
360	372
361		-	ENGR. H. B. NO. 1694 Page 8 1
	373	+	HB1694 HFLR Page 8
	374	+	BOLD FACE denotes Committee Amendments. 1
362	375		2
363	376		3
364	377		4
365	378		5
366	379		6
367	380		7
368	381		8
369	382		9
370	383		10
371	384		11
372	385		12
373	386		13
374	387		14
375	388		15
376	389		16
377	390		17
378	391		18
379	392		19
380	393		20
381	394		21
382	395		22
383	396		23
384	397		24
385	398
	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.
402	418
403		-	ENGR. H. B. NO. 1694 Page 9 1
404		-	2
405		-	3
406		-	4
407		-	5
408		-	6
409		-	7
410		-	8
411		-	9
412		-	10
413		-	11
414		-	12
415		-	13
416		-	14
417		-	15
418		-	16
419		-	17
420		-	18
421		-	19
422		-	20
423		-	21
424		-	22
425		-	23
426		-	24
427		-
428		-	Passed the House of Representatives the 14th day of March, 2023.
429		-
430		-
431		-
432		-
433		-	Presiding Officer of the House
434		-
435		-	of Representatives
436		-
437		-
438		-	Passed the Senate the ____ day of __________, 2023.
439		-
440		-
441		-
442		-
443		-	Presiding Officer of the Senate
444		-
	419	+	COMMITTEE REPORT BY: COMMITTEE ON INSURANCE, dated 03/01/2023 - DO
	420	+	PASS, As Amended and Coauthored.