Bill Text: IA HF2400 | 2023-2024 | 90th General Assembly | Enrolled

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Bill Title: A bill for an act relating to contracts and payments for dental care service plans. (Formerly HSB 638.) Effective date: 07/01/2024.

Spectrum: Committee Bill

Status: (Passed) 2024-04-10 - Signed by Governor. H.J. 773. [HF2400 Detail]

Download: Iowa-2023-HF2400-Enrolled.html

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House File 2400 - Enrolled
House File 2400
AN ACT
RELATING TO CONTRACTS AND PAYMENTS FOR DENTAL CARE SERVICE
PLANS.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
Section 1. NEW SECTION . 514C.3C Dental care service plan
contracts.
1. Definitions. As used in this section unless the context
otherwise provides:
a. “Commissioner” means the commissioner of insurance.
b. “Contracting entity” means any person, third-party
administrator, health carrier, or dental carrier that enters
into a contract with a dental care provider for the delivery
of dental care services.

House File 2400, p. 2
c. “Covered person” means a policyholder, subscriber,
enrollee, or other individual participating in a dental care
service plan or health benefit plan that provides for dental
care services.
d. “Dental care provider” means any person licensed to
practice dentistry pursuant to chapter 153, and who provides
dental care services pursuant to a dental care service plan or
health benefit plan.
e. “Dental care service plan” means a policy, contract,
plan, certificate, or agreement that provides for third-party
payment or prepayment of dental care services and that is
delivered or issued for delivery by or through a dental carrier
on a stand-alone basis. “Dental care service plan” includes a
health benefit plan that provides for dental care services.
f. “Dental care services” means the same as defined in
section 514J.102. “Dental care services” does not include
services that are billed as medical expenses under a health
benefit plan.
g. “Dental carrier” means an entity subject to the
insurance laws and regulations of this state, or subject to
the jurisdiction of the commissioner, including an insurance
company offering dental care service plans, or any other entity
that provides a dental care service plan.
h. “Dental service contractor” means any person who accepts
a prepayment from, or for the benefit of, another person as
consideration for the provision of future dental care services.
“Dental service contractor” does not include a dental care
provider that accepts prepayment on a fee-for-service basis for
providing specific dental services to individual patients for
whom such services have been prediagnosed.
i. “Dentist agent” means a person that contracts with
a dental care provider to establish an agency relationship
for purposes of processing bills for services provided by
the dental care provider under the terms and conditions
of a contract between the dentist agent and a health care
provider. A contract between a dentist agent and a health care
provider may permit the dentist agent to submit bills, request
reconsideration, and receive reimbursement.

House File 2400, p. 3
j. “Health benefit plan” means the same as defined in
section 514J.102.
k. “Health carrier” means the same as defined in section
514J.102.
l. “Network contract” means a contract between a contracting
entity and a dental care provider that specifies the rights and
responsibilities of the contracting entity and provides for the
delivery and payment of dental services to a covered person.
m. “Third party” means a person, not including a covered
person, that enters into a contract with a contracting entity
to access the dental services or contractual discounts of a
network contract. “Third party” does not include an employer or
other group for whom the dental carrier or contracting entity
provides administrative services.
n. “Virtual credit card payment” means an electronic funds
transfer in which a dental care service plan, or a contracted
vendor, issues a single-use series of numbers associated with
the payment of dental care services performed by a dental care
provider and chargeable to a predetermined dollar amount, where
the dental care provider is responsible for processing the
payment by a credit card terminal or internet portal. “Virtual
credit card payment” includes only electronic or virtual credit
card payments, where no physical credit card is used and
the single-use electronic credit card expires upon payment
processing.
2. Third-party access to network contracts.
a. A contracting entity may grant a third party access
to a network contract, or to a dental care provider’s dental
care services or contractual discounts provided pursuant to a
network contract, if all of the following requirements are met:
(1) If the contracting entity is a dental carrier or health
carrier, at the time the network contract is entered into,
renewed, or material modifications relevant to granting access
to a third party are made, the contracting entity allows any
dental care provider that is part of the contracting entity’s
network contract to choose not to participate in third-party
access to the network contract, or to enter into a contract
directly with the third party. If a dental care provider opts
out of lease arrangements, a contracting entity shall not

House File 2400, p. 4
cancel or terminate a contractual relationship with, or refuse
to contract with, the dental care provider.
(2) The network contract specifically states that the
contracting entity may enter into an agreement with a third
party to allow the third party to obtain the contracting
entity’s rights and responsibilities under the network
contract as if the third party were the contracting entity.
If the contracting entity is a dental carrier, the network
contract must specifically state that the dental care provider
may choose not to participate in third-party access to the
network contract, and that the dental care provider chose to
participate in third-party access at the time the network
contract was entered into or renewed.
(3) The third party accessing the network contract agrees to
comply with all of the network contract’s terms.
(4) The contracting entity identifies to the dental care
provider, in writing, all third parties participating in the
network contract as of the date the network contract is entered
into or renewed.
(5) The contracting entity provides a list of all
third parties participating in the network contract on the
contracting entity’s internet site and the list of third
parties is updated at least once every ninety days.
(6) The contracting entity notifies a dental care provider
under the network contract at least thirty days prior to a new
third party leasing or purchasing the network 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.
This subparagraph does not apply to an electronic transaction
mandated by the federal Health Insurance Portability and
Accountability Act of 1996, Pub. L. No. 104-191.
(8) The contracting entity notifies a third party of the
termination of a network contract no later than thirty days
from the termination date of the network contract.
(9) A third party’s right to a dental care provider’s
discounted rate is terminated as of the termination date of the
network contract.
(10) In the adjudication of a claim under the network

House File 2400, p. 5
contract, the contracting entity makes available to the
dental care provider a copy of the network contract no later
than thirty days after a request for the network contract is
received.
b. This section shall not apply to access to a network
contract provided to a third party that is either an affiliate
of, or operating under the same brand licensing as, the
contracting entity. A contracting entity shall provide a list
of all affiliates on the contracting entity’s internet site.
c. No dental care provider shall be bound by, or required to
perform, dental care services under a network contract that has
been granted to a third party in violation of this section.
3. Dental care service plans —— method of payment.
a. A dental care service plan shall not require payments
to be made to dental care providers by virtual credit card
payment.
b. A dental care service plan, when initiating payments to
a dental care provider via virtual credit card payment, or when
changing the method of payment for a dental care provider to
virtual credit card payments, shall do all of the following:
(1) Notify the dental care provider of any fees associated
with each payment method.
(2) Inform the dental care provider of the available options
for methods of payment and provide clear instructions to the
dental care provider for the selection of an alternative
payment method.
c. A dental care service plan that transmits payments to
a dental care provider in accordance with the standards of 45
C.F.R. §162.1601 and 162.1602 shall not charge a fee solely for
the transmission of the payment to the dental care provider
unless the dental care provider has consented to payment of
the fee. When transmitting a national automated clearinghouse
payment, a dentist agent may charge a reasonable fee related
to bank transmittal, transaction management, data management,
portal services, and other value-added services.
4. Waiver prohibited. The requirements of this section
shall not be waived by contract. Any contractual arrangement
contrary to this section shall be null and void.

House File 2400, p. 6
5. Rules. The commissioner may adopt rules pursuant to
chapter 17A to administer this chapter.
______________________________ ______________________________
PAT GRASSLEY AMY SINCLAIR
Speaker of the House President of the Senate
I hereby certify that this bill originated in the House and
is known as House File 2400, Ninetieth General Assembly.
______________________________
MEGHAN NELSON
Chief Clerk of the House
Approved _______________, 2024 ______________________________
KIM REYNOLDS
Governor