Relating to contracts and payments for dental care service plans

This bill relates to contracts and payments for dental care service plans. The bill permits a contracting entity to grant third-party access to a network contract (contract), or to a dental care provider’s (provider) dental care services or contractual discounts provided pursuant to a contract, if all of the following requirements are met: (1) the contracting entity allows a dental carrier or health carrier, at the time the contract is entered into, renewed, or modified, to choose not to participate in third-party access or to enter into a contract directly with the third party; (2) the contract states that the contracting entity may enter into an agreement to allow the third party to obtain the contracting entity’s rights and responsibilities under the contract; (3) the third party agrees to comply with all of the contract’s terms; (4) the contracting entity identifies to the provider all third parties participating in the contract when it is entered into or renewed; (5) the contracting entity provides a list of all third parties participating in the contract on the contracting entity’s internet site and the list is updated at least once every days; (6) the contracting entity notifies a provider at least days prior to a new third party leasing or purchasing the contract; (7) the contracting entity requires a third party to identify, for all remittance advice or explanations of payment under which a discount applies, the source of the discount; (8) the contracting entity notifies a third party no later than days from the termination date of the contract; (9) a third party’s right to a provider’s discounted rate is terminated as of the termination date of the contract; and (10) in the adjudication of a claim, the contracting entity makes available to the provider a copy of the contract no later than days after a request for the contract is received. “Contracting entity”, “dental care provider”, “network contract”, “third party”, “dental carrier”, and “health carrier” are defined in the bill. The bill prohibits a contracting entity from canceling or terminating a contractual relationship with a provider that chooses not to participate in third-party access. A provider shall not be bound by, or required to perform, dental care services under a contract that has been granted in violation of the bill. The bill prohibits a dental care service plan from requiring payments to be made to a provider by virtual credit card payment. “Virtual credit card payment” is defined in the bill. If a dental care service plan pays a provider via virtual credit card payment, the dental care service plan is required to notify the provider of any fees associated with each payment method, inform the provider of the available options for methods of payment, and provide clear instructions to the provider for the selection of an alternative payment method.1602 shall not charge a fee solely for the transmission unless the provider has consented to payment of the fee. A dentist agent that transmits payments through the national automated clearinghouse may charge a reasonable fee related to bank transmittal, transaction management, data management, portal services, and other value-added services. The requirements of the bill may not be waived by contract, and any contract contrary to the bill shall be null and void. The commissioner of insurance shall adopt rules to administer the bill.