Bill Text: IA SF2384 | 2023-2024 | 90th General Assembly | Introduced
Bill Title: A bill for an act relating to contracts and payments for dental care service plans.(Formerly SSB 3137.)
Spectrum: Committee Bill
Status: (Introduced - Dead) 2024-02-26 - Withdrawn. S.J. 386. [SF2384 Detail]
Download: Iowa-2023-SF2384-Introduced.html
Senate
File
2384
-
Introduced
SENATE
FILE
2384
BY
COMMITTEE
ON
COMMERCE
(SUCCESSOR
TO
SSB
3137)
A
BILL
FOR
An
Act
relating
to
contracts
and
payments
for
dental
care
1
service
plans.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
TLSB
5663SV
(3)
90
nls/ko
S.F.
2384
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
5663SV
(3)
90
nls/ko
1/
7
S.F.
2384
“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
5663SV
(3)
90
nls/ko
2/
7
S.F.
2384
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.
If
a
dental
care
provider
opts
15
out
of
lease
arrangements,
a
contracting
entity
shall
not
16
cancel
or
terminate
a
contractual
relationship
with,
or
refuse
17
to
contract
with,
the
dental
care
provider.
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
5663SV
(3)
90
nls/ko
3/
7
S.F.
2384
(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
thirty
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
from
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
5663SV
(3)
90
nls/ko
4/
7
S.F.
2384
payment.
1
b.
A
dental
care
service
plan,
when
initiating
payments
to
2
a
dental
care
provider
via
virtual
credit
card
payment,
or
when
3
changing
the
method
of
payment
for
a
dental
care
provider
to
4
virtual
credit
card
payments,
shall
do
all
of
the
following:
5
(1)
Notify
the
dental
care
provider
of
any
fees
associated
6
with
each
payment
method.
7
(2)
Inform
the
dental
care
provider
of
the
available
options
8
for
methods
of
payment
and
provide
clear
instructions
to
the
9
dental
care
provider
for
the
selection
of
an
alternative
10
payment
method.
11
c.
A
dental
care
service
plan
that
transmits
payments
to
12
a
dental
care
provider
in
accordance
with
the
standards
of
45
13
C.F.R.
§162.1601
and
162.1602
shall
not
charge
a
fee
solely
for
14
the
transmission
of
the
payment
to
the
dental
care
provider
15
unless
the
dental
care
provider
has
consented
to
payment
of
16
the
fee.
When
transmitting
a
national
automated
clearinghouse
17
payment,
a
dentist
agent
may
charge
a
reasonable
fee
related
18
to
bank
transmittal,
transaction
management,
data
management,
19
portal
services,
and
other
value-added
services.
20
4.
Waiver
prohibited.
The
requirements
of
this
section
21
shall
not
be
waived
by
contract.
Any
contract
contrary
to
this
22
section
shall
be
null
and
void.
23
5.
Rules.
The
commissioner
may
adopt
rules
pursuant
to
24
chapter
17A
to
administer
this
chapter.
25
EXPLANATION
26
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
27
the
explanation’s
substance
by
the
members
of
the
general
assembly.
28
This
bill
relates
to
contracts
and
payments
for
dental
care
29
service
plans.
30
The
bill
permits
a
contracting
entity
to
grant
third-party
31
access
to
a
network
contract
(contract),
or
to
a
dental
care
32
provider’s
(provider)
dental
care
services
or
contractual
33
discounts
provided
pursuant
to
a
contract,
if
all
of
the
34
following
requirements
are
met:
(1)
the
contracting
entity
35
-5-
LSB
5663SV
(3)
90
nls/ko
5/
7
S.F.
2384
allows
a
dental
carrier
or
health
carrier,
at
the
time
the
1
contract
is
entered
into,
renewed,
or
modified,
to
choose
2
not
to
participate
in
third-party
access
or
to
enter
into
a
3
contract
directly
with
the
third
party,
and
if
a
provider
4
opts
out
of
lease
arrangements,
a
contracting
entity
shall
5
not
cancel
or
terminate
a
contractual
relationship
with,
or
6
refuse
to
contract
with,
the
provider;
(2)
the
contract
states
7
that
the
contracting
entity
may
enter
into
an
agreement
to
8
allow
the
third
party
to
obtain
the
contracting
entity’s
9
rights
and
responsibilities
under
the
contract;
(3)
the
third
10
party
agrees
to
comply
with
all
of
the
contract’s
terms;
(4)
11
the
contracting
entity
identifies
to
the
provider
all
third
12
parties
participating
in
the
contract
when
it
is
entered
13
into
or
renewed;
(5)
the
contracting
entity
provides
a
list
14
of
all
third
parties
participating
in
the
contract
on
the
15
contracting
entity’s
internet
site
and
the
list
is
updated
at
16
least
once
every
90
days;
(6)
the
contracting
entity
notifies
a
17
provider
at
least
30
days
prior
to
a
new
third
party
leasing
or
18
purchasing
the
contract;
(7)
the
contracting
entity
requires
19
a
third
party
to
identify,
for
all
remittance
advice
or
20
explanations
of
payment
under
which
a
discount
applies,
the
21
source
of
the
discount;
(8)
the
contracting
entity
notifies
a
22
third
party
no
later
than
30
days
from
the
termination
date
23
of
the
contract;
(9)
a
third
party’s
right
to
a
provider’s
24
discounted
rate
is
terminated
as
of
the
termination
date
of
25
the
contract;
and
(10)
in
the
adjudication
of
a
claim,
the
26
contracting
entity
makes
available
to
the
provider
a
copy
of
27
the
contract
no
later
than
30
days
after
a
request
for
the
28
contract
is
received.
“Contracting
entity”,
“dental
care
29
provider”,
“network
contract”,
“third
party”,
“dental
carrier”,
30
and
“health
carrier”
are
defined
in
the
bill.
A
provider
shall
31
not
be
bound
by,
or
required
to
perform,
dental
care
services
32
under
a
contract
that
has
been
granted
in
violation
of
the
33
bill.
34
The
bill
prohibits
a
dental
care
service
plan
from
requiring
35
-6-
LSB
5663SV
(3)
90
nls/ko
6/
7
S.F.
2384
payments
to
be
made
to
a
provider
by
virtual
credit
card
1
payment.
“Virtual
credit
card
payment”
is
defined
in
the
2
bill.
A
dental
care
service
plan,
when
initiating
payments
3
to,
or
changing
payment
methods
for,
a
provider
via
virtual
4
credit
card
payment,
the
dental
care
service
plan
is
required
5
to
notify
the
provider
of
any
fees
associated
with
each
6
payment
method,
inform
the
provider
of
the
available
options
7
for
methods
of
payment,
and
provide
clear
instructions
to
the
8
provider
for
the
selection
of
an
alternative
payment
method.
A
9
dental
care
service
plan
that
transmits
payments
to
a
provider
10
in
accordance
with
the
standards
of
45
C.F.R.
§162.1601
and
11
162.1602
shall
not
charge
a
fee
solely
for
the
transmission
12
unless
the
provider
has
consented
to
payment
of
the
fee.
A
13
dentist
agent
that
transmits
payments
through
the
national
14
automated
clearinghouse
may
charge
a
reasonable
fee
related
15
to
bank
transmittal,
transaction
management,
data
management,
16
portal
services,
and
other
value-added
services.
17
The
requirements
of
the
bill
shall
not
be
waived
by
contract,
18
and
any
contract
to
the
contrary
is
null
and
void.
19
The
commissioner
of
insurance
may
adopt
rules
to
administer
20
the
bill.
21
-7-
LSB
5663SV
(3)
90
nls/ko
7/
7
