2022 -- S 2466 | |
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LC004955 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2022 | |
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A N A C T | |
RELATING TO INSURANCE -- HEALTH CARE ACCESSIBILITY AND QUALITY | |
ASSURANCE ACT -- DENTAL INSURANCE | |
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Introduced By: Senators Miller, DiMario, Lawson, and Valverde | |
Date Introduced: March 01, 2022 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Section 27-18.8-4 of the General Laws in Chapter 27-18.8 entitled "Health |
2 | Care Accessibility and Quality Assurance Act" is hereby amended to read as follows: |
3 | 27-18.8-4. Contracts with providers for dental services. |
4 | (a) No contract between a dental plan of a healthcare entity and a dentist for the provision |
5 | of services to beneficiaries may require that a dentist provide services to its patients at a fee set by |
6 | the healthcare entity unless said services are covered services under the applicable subscriber |
7 | agreement. "Covered services," as used herein, means services reimbursable under the applicable |
8 | beneficiary agreement, subject to such contractual limitations on beneficiary benefits as may apply, |
9 | including, for example, deductibles, waiting period, or frequency limitations. |
10 | (b) Dental services rendered to patients in Rhode Island shall be governed by the Rhode |
11 | Island general laws. |
12 | SECTION 2. Sections 27-18-56 and 27-18-63 of the General Laws in Chapter 27-18 |
13 | entitled "Accident and Sickness Insurance Policies" are hereby amended to read as follows: |
14 | 27-18-56. Prohibition against dentists being required to indemnify provider. |
15 | (a) No accident and sickness insurance provider may contract to require that a dentist |
16 | indemnify or hold harmless the accident and sickness insurance provider for any expenses and |
17 | liabilities, including, without limitation, judgments, settlements, attorneys' fees, court costs, and |
18 | any associated charges, incurred in connection with any claim or action brought against the accident |
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1 | and sickness insurance provider based on the accident and sickness insurance provider's |
2 | management decisions or utilization review provisions for any patient. |
3 | (b) Dental services rendered to patients in Rhode Island shall be governed by the Rhode |
4 | Island general laws, including, but not limited to, chapter 18.8 of this title. |
5 | 27-18-63. Dental insurance assignment of benefits. Dental insurance. |
6 | (a) Every entity providing a policy of accident and sickness insurance as defined in this |
7 | chapter shall allow, as a provision in a group or individual policy, contract or health benefit plan |
8 | for coverage of dental services, any person insured by such entity to direct, in writing, that benefits |
9 | from a health benefit plan, policy or contract, be paid directly to a dental care provider who has not |
10 | contracted with the entity to provide dental services to persons covered by the entity but otherwise |
11 | meets the credentialing criteria of the entity and has not previously been terminated by such entity |
12 | as a participating provider. If written direction to pay is executed and written notice of the direction |
13 | to pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care |
14 | provider. Any efforts to modify the amount of benefits paid directly to the dental care provider |
15 | under this section may include a reduction in benefits paid of no more than five percent (5%) less |
16 | than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction |
17 | to pay duly executed by the subscriber, shall have the right to review the records of the dentist |
18 | receiving such payment that relate exclusively to that particular subscriber/patient to determine that |
19 | the service in question was rendered. Provided, however, this section shall not apply to insurance |
20 | coverage providing benefits for: |
21 | (1) Hospital confinement indemnity; |
22 | (2) Disability income; |
23 | (3) Accident only; |
24 | (4) Long-term care; |
25 | (5) Medicare supplement; |
26 | (6) Limited benefit health; |
27 | (7) Specified disease indemnity; |
28 | (8) Sickness or bodily injury or death by accident or both; and |
29 | (9) Other limited benefit policies. |
30 | (b) Dental services rendered to patients in Rhode Island shall be governed by the Rhode |
31 | Island general laws, including, but not limited to, chapter 18.8 of this title. |
32 | SECTION 3. Section 27-19-54 of the General Laws in Chapter 27-19 entitled "Nonprofit |
33 | Hospital Service Corporations" is hereby amended to read as follows: |
34 | 27-19-54. Dental insurance assignment of benefits. Dental insurance. |
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1 | (a) Every entity providing a contract of insurance subject to this chapter shall allow, as a |
2 | provision in a group or individual policy, contract or health benefit plan for coverage of dental |
3 | services, any person insured by such entity to direct, in writing, that benefits from a health benefit |
4 | plan, policy or contract, be paid directly to a dental care provider who has not contracted with the |
5 | entity to provide dental services to persons covered by the entity but otherwise meets the |
6 | credentialing criteria of the entity and has not previously been terminated by such entity as a |
7 | participating provider. If written direction to pay is executed and written notice of the direction to |
8 | pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care |
9 | provider. Any efforts to modify the amount of benefits paid directly to the dental care provider |
10 | under this section may include a reduction in benefits paid of no more than five percent (5%) less |
11 | than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction |
12 | to pay duly executed by the subscriber, shall have the right to review the records of the dentist |
13 | receiving such payment that relate exclusively to that particular subscriber/patient to determine that |
14 | the service in question was rendered. |
15 | (b) Dental services rendered to patients in Rhode Island shall be governed by the Rhode |
16 | Island general laws, including, but not limited to, chapter 18.8 of this title. |
17 | SECTION 4. Section 27-20-49 of the General Laws in Chapter 27-20 entitled "Nonprofit |
18 | Medical Service Corporations" is hereby amended to read as follows: |
19 | 27-20-49. Dental insurance assignment of benefits. Dental insurance. |
20 | (a) Every entity providing a contract of insurance as defined in this chapter shall allow, as |
21 | a provision in a group or individual policy, contract or health benefit plan for coverage of dental |
22 | services, any person insured by such entity to direct, in writing, that benefits from a health benefit |
23 | plan, policy or contract, be paid directly to a dental care provider who has not contracted with the |
24 | entity to provide dental services to persons covered by the entity but otherwise meets the |
25 | credentialing criteria of the entity and has not previously been terminated by such entity as a |
26 | participating provider. If written direction to pay is executed and written notice of the direction to |
27 | pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care |
28 | provider. Any efforts to modify the amount of benefits paid directly to the dental care provider |
29 | under this section may include a reduction in benefits paid of no more than five percent (5%) less |
30 | than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction |
31 | to pay duly executed by the subscriber, shall have the right to review the records of the dentist |
32 | receiving such payment that relate exclusively to that particular subscriber/patient to determine that |
33 | the service in question was rendered. |
34 | (b) Dental services rendered to patients in Rhode Island shall be governed by the Rhode |
| LC004955 - Page 3 of 6 |
1 | Island general laws, including, but not limited to, chapter 18.8 of this title. |
2 | SECTION 5. Section 27-20.1-3 of the General Laws in Chapter 27-20.1 entitled "Nonprofit |
3 | Dental Service Corporations" is hereby amended to read as follows: |
4 | 27-20.1-3. Contracts. |
5 | (a) Each nonprofit dental service corporation may contract with its subscribers for a dental |
6 | service as may be provided under any nonprofit dental service plan adopted by the corporation. |
7 | (b) The rates charged by the nonprofit dental service corporation to its subscribers shall be |
8 | consistent with the proper conduct of its business and the interests of the public and shall at all |
9 | times be subject to the approval of the director of business regulation. |
10 | (c) Nothing contained in this chapter or in any nonprofit dental service plan shall affect the |
11 | ordinary professional relationship between the person rendering dental services under the plan and |
12 | the subscriber to whom the services are rendered; and no action based upon or arising out of the |
13 | relationship or relating to dental services rendered pursuant to a nonprofit dental service plan shall |
14 | be maintained against the nonprofit dental service corporation operating the plan. |
15 | (d) No contract between a nonprofit dental service corporation and a dentist for the |
16 | provisions of services to patients may require that the dentist indemnify or hold harmless the |
17 | nonprofit dental service corporation for any expenses and liabilities, including without limitation, |
18 | judgments, settlements, attorneys' fee, court costs, and any associated charges, incurred in |
19 | connection with any claim or action brought against the nonprofit dental service corporation based |
20 | on the nonprofit dental service corporation's management decisions, or utilization review |
21 | provisions for any patient. |
22 | (e) Dental services rendered to patients in Rhode Island shall be governed by the Rhode |
23 | Island general laws, including, but not limited to, chapter 18.8 of this title. |
24 | SECTION 6. Sections 27-41-58 and 27-41-66 of the General laws in Chapter 27-41 entitled |
25 | "Health Maintenance Organizations" are hereby amended to read as follows: |
26 | 27-41-58. Prohibition against requiring indemnification from dentists. |
27 | (a) No contract between a health maintenance organization (H.M.O.) and a dentist |
28 | containing provisions for the provision of services to patients may require that the dentist indemnify |
29 | or hold harmless the health maintenance organization for any expenses and liabilities, including |
30 | without limitation, judgments, settlements, attorneys' fees, court costs, and any associated charges, |
31 | incurred in connection with any claim or action brought against the H.M.O. based on the H.M.O.'s |
32 | management decisions, or utilization review provisions for any patient. |
33 | (b) Dental services rendered to patients in Rhode Island shall be governed by the Rhode |
34 | Island general laws, including, but not limited to, chapter 18.8 of this title. |
| LC004955 - Page 4 of 6 |
1 | 27-41-66. Dental insurance assignment of benefits. Dental insurance. |
2 | (a) Every entity licensed under this chapter shall allow, as a provision of any evidence of |
3 | coverage of dental services, any person covered by such entity to direct, in writing, that benefits |
4 | from a health benefit plan, policy or contract, be paid directly to a dental care provider who has not |
5 | contracted with the entity to provide dental services to persons covered by the entity but otherwise |
6 | meets the credentialing criteria of the entity and has not previously been terminated by such entity |
7 | as a participating provider. If written direction to pay is executed and written notice of the direction |
8 | to pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care |
9 | provider. Any efforts to modify the amount of benefits paid directly to the dental care provider |
10 | under this section may include a reduction in benefits paid of no more than five percent (5%) less |
11 | than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction |
12 | to pay duly executed by the subscriber, shall have the right to review the records of the dentist |
13 | receiving such payment that relate exclusively to that particular subscriber/patient to determine that |
14 | the service in question was rendered. |
15 | (b) Dental services rendered to patients in Rhode Island shall be governed by the Rhode |
16 | Island general laws. |
17 | SECTION 7. This act shall take effect upon passage. |
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LC004955 | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- HEALTH CARE ACCESSIBILITY AND QUALITY | |
ASSURANCE ACT -- DENTAL INSURANCE | |
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1 | This act would provide that dental services rendered to patients in Rhode Island shall be |
2 | governed by Rhode Island law. |
3 | This act would take effect upon passage. |
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LC004955 | |
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