2022 -- H 7667

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LC005079

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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 – ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Kennedy, Azzinaro, and Diaz

     Date Introduced: March 02, 2022

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Sections 27-18-56 and 27-18-63 of the General Laws in Chapter 27-18

entitled "Accident and Sickness Insurance Policies" are hereby amended to read as follows:

     27-18-56. Prohibition against dentists being required to indemnify provider.

     (a) No accident and sickness insurance provider may contract to require that a dentist

indemnify or hold harmless the accident and sickness insurance provider for any expenses and

liabilities, including, without limitation, judgments, settlements, attorneys' fees, court costs, and

any associated charges, incurred in connection with any claim or action brought against the accident

and sickness insurance provider based on the accident and sickness insurance provider's

management decisions or utilization review provisions for any patient.

     (b) Dental services rendered to patients in Rhode Island shall be governed by Rhode Island

general laws, including, but not limited to, chapter 18.8 of this title.

     27-18-63. Dental insurance assignment of benefits.

     (a) Every entity providing a policy of accident and sickness insurance as defined in this

chapter shall allow, as a provision in a group or individual policy, contract or health benefit plan

for coverage of dental services, any person insured by such entity to direct, in writing, that benefits

from a health benefit plan, policy or contract, be paid directly to a dental care provider who has not

contracted with the entity to provide dental services to persons covered by the entity but otherwise

meets the credentialing criteria of the entity and has not previously been terminated by such entity

as a participating provider. If written direction to pay is executed and written notice of the direction

to pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care

provider. Any efforts to modify the amount of benefits paid directly to the dental care provider

under this section may include a reduction in benefits paid of no more than five percent (5%) less

than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction

to pay duly executed by the subscriber, shall have the right to review the records of the dentist

receiving such payment that relate exclusively to that particular subscriber/patient to determine that

the service in question was rendered. Provided, however, this section shall not apply to insurance

coverage providing benefits for:

     (1) Hospital confinement indemnity;

     (2) Disability income;

     (3) Accident only;

     (4) Long-term care;

     (5) Medicare supplement;

     (6) Limited benefit health;

     (7) Specified disease indemnity;

     (8) Sickness or bodily injury or death by accident or both; and

     (9) Other limited benefit policies.

     (b) Dental services rendered to patients in Rhode Island shall be governed by Rhode Island

general laws, including, but not limited to, chapter 18.8 of this title.

     SECTION 2. Section 27-18.8-4 of the General Laws in Chapter 27-18.8 entitled "Health

Care Accessibility and Quality Assurance Act" is hereby amended to read as follows:

     27-18.8-4. Contracts with providers for dental services.

     (a) No contract between a dental plan of a healthcare entity and a dentist for the provision

of services to beneficiaries may require that a dentist provide services to its patients at a fee set by

the healthcare entity unless said services are covered services under the applicable subscriber

agreement. "Covered services," as used herein, means services reimbursable under the applicable

beneficiary agreement, subject to such contractual limitations on beneficiary benefits as may apply,

including, for example, deductibles, waiting period, or frequency limitations.

     (b) Dental services rendered to patients in Rhode Island shall be governed by Rhode Island

general laws.

     SECTION 3. Section 27-19-54 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-54. Dental insurance assignment of benefits.

     (a) Every entity providing a contract of insurance subject to this chapter shall allow, as a

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provision in a group or individual policy, contract or health benefit plan for coverage of dental

services, any person insured by such entity to direct, in writing, that benefits from a health benefit

plan, policy or contract, be paid directly to a dental care provider who has not contracted with the

entity to provide dental services to persons covered by the entity but otherwise meets the

credentialing criteria of the entity and has not previously been terminated by such entity as a

participating provider. If written direction to pay is executed and written notice of the direction to

pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care

provider. Any efforts to modify the amount of benefits paid directly to the dental care provider

under this section may include a reduction in benefits paid of no more than five percent (5%) less

than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction

to pay duly executed by the subscriber, shall have the right to review the records of the dentist

receiving such payment that relate exclusively to that particular subscriber/patient to determine that

the service in question was rendered.

     (b) Dental services rendered to patients in Rhode Island shall be governed by Rhode Island

general laws, including, but not limited to, chapter 18.8 of this title.

     SECTION 4. Section 27-20-49 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-49. Dental insurance assignment of benefits. Dental insurance.

     (a) Every entity providing a contract of insurance as defined in this chapter shall allow, as

a provision in a group or individual policy, contract or health benefit plan for coverage of dental

services, any person insured by such entity to direct, in writing, that benefits from a health benefit

plan, policy or contract, be paid directly to a dental care provider who has not contracted with the

entity to provide dental services to persons covered by the entity but otherwise meets the

credentialing criteria of the entity and has not previously been terminated by such entity as a

participating provider. If written direction to pay is executed and written notice of the direction to

pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care

provider. Any efforts to modify the amount of benefits paid directly to the dental care provider

under this section may include a reduction in benefits paid of no more than five percent (5%) less

than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction

to pay duly executed by the subscriber, shall have the right to review the records of the dentist

receiving such payment that relate exclusively to that particular subscriber/patient to determine that

the service in question was rendered.

     (b) Dental services rendered to patients in Rhode Island shall be governed by Rhode Island

general laws, including, but not limited to, chapter 18.8 of this title.

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     SECTION 5. Section 27-20.1-3 of the General Laws in Chapter 27-20.1 entitled "Nonprofit

Dental Service Corporations" is hereby amended to read as follows:

     27-20.1-3. Contracts.

     (a) Each nonprofit dental service corporation may contract with its subscribers for a dental

service as may be provided under any nonprofit dental service plan adopted by the corporation.

     (b) The rates charged by the nonprofit dental service corporation to its subscribers shall be

consistent with the proper conduct of its business and the interests of the public and shall at all

times be subject to the approval of the director of business regulation.

     (c) Nothing contained in this chapter or in any nonprofit dental service plan shall affect the

ordinary professional relationship between the person rendering dental services under the plan and

the subscriber to whom the services are rendered; and no action based upon or arising out of the

relationship or relating to dental services rendered pursuant to a nonprofit dental service plan shall

be maintained against the nonprofit dental service corporation operating the plan.

     (d) No contract between a nonprofit dental service corporation and a dentist for the

provisions of services to patients may require that the dentist indemnify or hold harmless the

nonprofit dental service corporation for any expenses and liabilities, including without limitation,

judgments, settlements, attorneys' fee, court costs, and any associated charges, incurred in

connection with any claim or action brought against the nonprofit dental service corporation based

on the nonprofit dental service corporation's management decisions, or utilization review

provisions for any patient.

     (e) Dental services rendered to patients in Rhode Island shall be governed by Rhode Island

general laws, including, but not limited to, chapter 18.8 of this title.

     SECTION 6. Sections 27-41-58 and 27-41-66 of the General Laws in Chapter 27-41

entitled "Health Maintenance Organizations" are hereby amended to read as follows:

     27-41-58. Prohibition against requiring indemnification from dentists.

     (a) No contract between a health maintenance organization (H.M.O.) and a dentist

containing provisions for the provision of services to patients may require that the dentist indemnify

or hold harmless the health maintenance organization for any expenses and liabilities, including

without limitation, judgments, settlements, attorneys' fees, court costs, and any associated charges,

incurred in connection with any claim or action brought against the H.M.O. based on the H.M.O.'s

management decisions, or utilization review provisions for any patient.

     (b) Dental services rendered to patients in Rhode Island shall be governed by Rhode Island

general laws including, but not limited to, chapter 18.8 of this title.

     27-41-66. Dental insurance assignment of benefits.

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     (a) Every entity licensed under this chapter shall allow, as a provision of any evidence of

coverage of dental services, any person covered by such entity to direct, in writing, that benefits

from a health benefit plan, policy or contract, be paid directly to a dental care provider who has not

contracted with the entity to provide dental services to persons covered by the entity but otherwise

meets the credentialing criteria of the entity and has not previously been terminated by such entity

as a participating provider. If written direction to pay is executed and written notice of the direction

to pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care

provider. Any efforts to modify the amount of benefits paid directly to the dental care provider

under this section may include a reduction in benefits paid of no more than five percent (5%) less

than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction

to pay duly executed by the subscriber, shall have the right to review the records of the dentist

receiving such payment that relate exclusively to that particular subscriber/patient to determine that

the service in question was rendered.

     (b) Dental services rendered to patients in Rhode Island shall be governed by Rhode Island

general laws including, but not limited to, chapter 18.8 of this title.

     SECTION 7. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE – ACCIDENT AND SICKNESS INSURANCE POLICIES

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     This act would require that the laws of the state where the medical services are rendered

shall be the state law that applies to reimbursement.

     This act would take effect upon passage.

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LC005079

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