S.F. _____ Section 1. NEW SECTION . 514C.3C Dental care service plan 1 contracts. 2 1. Definitions. As used in this section unless the context 3 otherwise provides: 4 a. “Commissioner” means the commissioner of insurance. 5 b. “Contracting entity” means any person, third-party 6 administrator, health carrier, or dental carrier that enters 7 into a contract with a dental care provider for the delivery 8 of dental care services. 9 c. “Covered person” means a policyholder, subscriber, 10 enrollee, or other individual participating in a dental care 11 service plan or health benefit plan that provides for dental 12 care services. 13 d. “Dental care provider” means any person licensed to 14 practice dentistry pursuant to chapter 153, and who provides 15 dental care services pursuant to a dental care service plan or 16 health benefit plan. 17 e. “Dental care service plan” means a policy, contract, 18 plan, certificate, or agreement that provides for third-party 19 payment or prepayment of dental care services and that is 20 delivered or issued for delivery by or through a dental carrier 21 on a stand-alone basis. “Dental care service plan” includes a 22 health benefit plan that provides for dental care services. 23 f. “Dental care services” means the same as defined in 24 section 514J.102. “Dental care services” does not include 25 services that are billed as medical expenses under a health 26 benefit plan. 27 g. “Dental carrier” means an entity subject to the 28 insurance laws and regulations of this state, or subject to 29 the jurisdiction of the commissioner, including an insurance 30 company offering dental care service plans, or any other entity 31 that provides a dental care service plan. 32 h. “Dental service contractor” means any person who accepts 33 a prepayment from, or for the benefit of, another person as 34 consideration for the provision of future dental care services. 35 -1- LSB 5663XC (5) 90 nls/ko 1/ 7

S.F. _____ “Dental service contractor” does not include a dental care 1 provider that accepts prepayment on a fee-for-service basis for 2 providing specific dental services to individual patients for 3 whom such services have been prediagnosed. 4 i. “Dentist agent” means a person that contracts with 5 a dental care provider to establish an agency relationship 6 for purposes of processing bills for services provided by 7 the dental care provider under the terms and conditions 8 of a contract between the dentist agent and a health care 9 provider. A contract between a dentist agent and a health care 10 provider may permit the dentist agent to submit bills, request 11 reconsideration, and receive reimbursement. 12 j. “Health benefit plan” means the same as defined in 13 section 514J.102. 14 k. “Health carrier” means the same as defined in section 15 514J.102. 16 l. “Network contract” means a contract between a contracting 17 entity and a dental care provider that specifies the rights and 18 responsibilities of the contracting entity and provides for the 19 delivery and payment of dental services to a covered person. 20 m. “Third party” means a person, not including a covered 21 person, that enters into a contract with a contracting entity 22 to access the dental services or contractual discounts of a 23 network contract. “Third party” does not include an employer or 24 other group for whom the dental carrier or contracting entity 25 provides administrative services. 26 n. “Virtual credit card payment” means an electronic funds 27 transfer in which a dental care service plan, or a contracted 28 vendor, issues a single-use series of numbers associated with 29 the payment of dental care services performed by a dental care 30 provider and chargeable to a predetermined dollar amount, where 31 the dental care provider is responsible for processing the 32 payment by a credit card terminal or internet portal. “Virtual 33 credit card payment” includes only electronic or virtual credit 34 card payments, where no physical credit card is used and 35 -2- LSB 5663XC (5) 90 nls/ko 2/ 7

S.F. _____ the single-use electronic credit card expires upon payment 1 processing. 2 2. Third-party access to network contracts. 3 a. A contracting entity may grant a third party access 4 to a network contract, or to a dental care provider’s dental 5 care services or contractual discounts provided pursuant to a 6 network contract, if all of the following requirements are met: 7 (1) If the contracting entity is a dental carrier or health 8 carrier, at the time the network contract is entered into, 9 renewed, or material modifications relevant to granting access 10 to a third party are made, the contracting entity allows any 11 dental care provider that is part of the contracting entity’s 12 network contract to choose not to participate in third-party 13 access to the network contract, or to enter into a contract 14 directly with the third party. A contracting entity shall not 15 cancel or terminate a contractual relationship with, or refuse 16 to contract with, a dental care provider who chooses not to 17 participate in third-party access to the network contract. 18 (2) The network contract specifically states that the 19 contracting entity may enter into an agreement with a third 20 party to allow the third party to obtain the contracting 21 entity’s rights and responsibilities under the network 22 contract as if the third party were the contracting entity. 23 If the contracting entity is a dental carrier, the network 24 contract must specifically state that the dental care provider 25 may choose not to participate in third-party access to the 26 network contract, and that the dental care provider chose to 27 participate in third-party access at the time the network 28 contract was entered into or renewed. 29 (3) The third party accessing the network contract agrees to 30 comply with all of the network contract’s terms. 31 (4) The contracting entity identifies to the dental care 32 provider, in writing, all third parties participating in the 33 network contract as of the date the network contract is entered 34 into or renewed. 35 -3- LSB 5663XC (5) 90 nls/ko 3/ 7

S.F. _____ (5) The contracting entity provides a list of all 1 third parties participating in the network contract on the 2 contracting entity’s internet site and the list of third 3 parties is updated at least once every ninety days. 4 (6) The contracting entity notifies a dental care provider 5 under the network contract at least ninety days prior to a new 6 third party leasing or purchasing the network contract. 7 (7) The contracting entity requires a third party to 8 identify, for all remittance advice or explanations of payment 9 under which a discount applies, the source of the discount. 10 This subparagraph does not apply to an electronic transaction 11 mandated by the federal Health Insurance Portability and 12 Accountability Act of 1996, Pub. L. No. 104-191. 13 (8) The contracting entity notifies a third party of the 14 termination of a network contract no later than thirty days 15 prior to the termination date of the network contract. 16 (9) A third party’s right to a dental care provider’s 17 discounted rate is terminated as of the termination date of the 18 network contract. 19 (10) In the adjudication of a claim under the network 20 contract, the contracting entity makes available to the 21 dental care provider a copy of the network contract no later 22 than thirty days after a request for the network contract is 23 received. 24 b. This section shall not apply to access to a network 25 contract provided to a third party that is either an affiliate 26 of, or operating under the same brand licensing as, the 27 contracting entity. A contracting entity shall provide a list 28 of all affiliates on the contracting entity’s internet site. 29 c. No dental care provider shall be bound by, or required to 30 perform, dental care services under a network contract that has 31 been granted to a third party in violation of this section. 32 3. Dental care service plans —— method of payment. 33 a. A dental care service plan shall not require payments 34 to be made to dental care providers by virtual credit card 35 -4- LSB 5663XC (5) 90 nls/ko 4/ 7

S.F. _____ payment. 1 b. A dental care service plan, when making payments to a 2 dental care provider via virtual credit card payments, shall 3 do all of the following: 4 (1) Notify the dental care provider of any fees associated 5 with each payment method. 6 (2) Inform the dental care provider of the available options 7 for methods of payment and provide clear instructions to the 8 dental care provider for the selection of an alternative 9 payment method. 10 c. A dental care service plan that transmits payments to 11 a dental care provider in accordance with the standards of 45 12 C.F.R. §162.1601 and 162.1602 shall not charge a fee for the 13 transmission of the payment to the dental care provider unless 14 the dental care provider has consented to payment of the fee. 15 When transmitting a national automated clearinghouse payment, 16 a dentist agent may charge a reasonable fee related to bank 17 transmittal, transaction management, data management, portal 18 services, and other value-added services. 19 4. Rules. The commissioner shall adopt rules pursuant to 20 chapter 17A to administer this chapter. 21 EXPLANATION 22 The inclusion of this explanation does not constitute agreement with 23 the explanation’s substance by the members of the general assembly. 24 This bill relates to contracts and payments for dental care 25 service plans. 26 The bill permits a contracting entity to grant third-party 27 access to a network contract (contract), or to a dental care 28 provider’s (provider) dental care services or contractual 29 discounts provided pursuant to a contract, if all of the 30 following requirements are met: (1) the contracting entity 31 allows a dental carrier or health carrier, at the time the 32 contract is entered into, renewed, or modified, to choose 33 not to participate in third-party access or to enter into 34 a contract directly with the third party; (2) the contract 35 -5- LSB 5663XC (5) 90 nls/ko 5/ 7

S.F. _____ states that the contracting entity may enter into an agreement 1 to allow the third party to obtain the contracting entity’s 2 rights and responsibilities under the contract; (3) the third 3 party agrees to comply with all of the contract’s terms; (4) 4 the contracting entity identifies to the provider all third 5 parties participating in the contract when it is entered 6 into or renewed; (5) the contracting entity provides a list 7 of all third parties participating in the contract on the 8 contracting entity’s internet site and the list is updated at 9 least once every 90 days; (6) the contracting entity notifies a 10 provider at least 90 days prior to a new third party leasing or 11 purchasing the contract; (7) the contracting entity requires 12 a third party to identify, for all remittance advice or 13 explanations of payment under which a discount applies, the 14 source of the discount; (8) the contracting entity notifies 15 a third party no later than 30 days prior to the termination 16 date of the contract; (9) a third party’s right to a provider’s 17 discounted rate is terminated as of the termination date of 18 the contract; and (10) in the adjudication of a claim, the 19 contracting entity makes available to the provider a copy of 20 the contract no later than 30 days after a request for the 21 contract is received. “Contracting entity”, “dental care 22 provider”, “network contract”, “third party”, “dental carrier”, 23 and “health carrier” are defined in the bill. The bill 24 prohibits a contracting entity from canceling, terminating, or 25 refusing to form a contractual relationship with a provider 26 that chooses not to participate in third-party access. A 27 provider shall not be bound by, or required to perform, 28 dental care services under a contract that has been granted in 29 violation of the bill. 30 The bill prohibits a dental care service plan from requiring 31 payments to be made to a provider by virtual credit card 32 payment. “Virtual credit card payment” is defined in the bill. 33 If a dental care service plan pays a provider via virtual 34 credit card payment, the dental care service plan is required 35 -6- LSB 5663XC (5) 90 nls/ko 6/ 7

S.F. _____ to notify the provider of any fees associated with each 1 payment method, inform the provider of the available options 2 for methods of payment, and provide clear instructions to the 3 provider for the selection of an alternative payment method. A 4 dental care service plan that transmits payments to a provider 5 in accordance with the standards of 45 C.F.R. §162.1601 and 6 162.1602 shall not charge a fee for the transmission unless 7 the provider has consented to payment of the fee. A dentist 8 agent that transmits payments through the national automated 9 clearinghouse may charge a reasonable fee related to bank 10 transmittal, transaction management, data management, portal 11 services, and other value-added services. 12 The commissioner of insurance shall adopt rules to 13 administer the bill. 14 -7- LSB 5663XC (5) 90 nls/ko 7/ 7