House File 2117 - Introduced HOUSE FILE 2117 BY T. OLSON A BILL FOR An Act concerning payments for certain dental care services 1 including fee schedules for dental services and assignment 2 of dental care coverage benefits. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 5832HH (5) 83 av/nh

H.F. 2117 Section 1. NEW SECTION . 514C.3B Dental coverage —— fee 1 schedules. 2 1. A contract between a dental plan and a dentist for the 3 provision of services to covered individuals under the plan 4 shall not require that a dentist provide services to those 5 covered individuals at a fee set by the dental plan unless such 6 services are covered services under the dental plan. 7 2. A person or entity providing third-party administrator 8 services shall not make available any dentists in its dentist 9 network to a dental plan that does any of the following: 10 a. Sets fees for dental services that are not covered 11 services. 12 b. Sets fees for dental services that exceed the maximum fee 13 for dental services covered by the dental plan. 14 3. For the purposes of this section: 15 a. “Covered services” means services reimbursed under the 16 dental plan. 17 b. “Dental plan” means any policy or contract of insurance 18 which provides for coverage of dental services not in 19 connection with a medical plan that provides for the coverage 20 of medical services. 21 Sec. 2. NEW SECTION . 514C.3C Assignment of dental care 22 coverage benefits. 23 1. A carrier as defined in section 513B.2; an organized 24 delivery system authorized under 1993 Iowa Acts, ch. 158, 25 and licensed by the director of public health; or a plan 26 established pursuant to chapter 509A for public employees, 27 shall not do either of the following: 28 a. Prohibit the assignment of dental care coverage benefits 29 to a dental care provider by a covered individual. 30 b. Refuse to directly reimburse a dental care provider 31 pursuant to a valid assignment of dental care coverage benefits 32 after receipt of written notice of the assignment. 33 2. An assignment of benefits as described in this section 34 shall not affect or limit the payment of benefits otherwise 35 -1- LSB 5832HH (5) 83 av/nh 1/ 3

H.F. 2117 payable under a dental care benefit contract, policy, or plan 1 and a covered individual shall not be otherwise penalized for 2 making such an assignment of benefits. 3 3. A payment of benefits made under a dental care benefit 4 contract, policy, or plan prior to receipt of written notice 5 of assignment of the benefits shall be without prejudice to 6 the payor. This section shall not be construed to prevent the 7 reconciliation of erroneous or duplicate payments made. 8 4. For the purposes of this section, unless the context 9 otherwise requires: 10 a. “Assignment of benefits” means the transfer of dental 11 care coverage reimbursement benefits or other rights under an 12 insurance contract, policy, or plan by a covered individual to 13 a dental care provider. 14 b. “Dental care provider” means a dentist, dental hygienist, 15 or dental assistant registered or licensed to practice under 16 chapter 153. 17 EXPLANATION 18 This bill creates new Code section 514C.3B which prohibits 19 a dental plan from setting fee schedules for participating 20 dentists for the provision of dental services that are not 21 covered by the plan. The bill also prohibits a third-party 22 administrator from making a dentist in its provider network 23 available to a dental plan that sets fees for services that are 24 not covered or sets fees for dental services that exceed the 25 maximum fee for dental services covered by the dental plan. 26 For the purposes of new Code section 514C.3B, a “covered 27 service” is a service reimbursed under the applicable dental 28 plan. A “dental plan” is any policy or contract of insurance 29 which provides for coverage of dental services not in 30 connection with a medical plan which provides for the coverage 31 of medical services. 32 The bill also creates new Code section 514C.3C which 33 prohibits a carrier, organized delivery system, or plan for 34 public employees from refusing to allow a covered individual to 35 -2- LSB 5832HH (5) 83 av/nh 2/ 3

H.F. 2117 assign payment of dental care coverage benefits to dental care 1 provider, or from refusing to directly reimburse a dental care 2 provider, pursuant to a valid assignment of such benefits upon 3 receipt of written notice of the assignment. 4 -3- LSB 5832HH (5) 83 av/nh 3/ 3