2023 -- H 5677

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LC001698

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO INSURANCE -- HEALTH CARE ACCESSIBILITY AND QUALITY

ASSURANCE ACT

     

     Introduced By: Representative Joseph M. McNamara

     Date Introduced: February 17, 2023

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 27-18.8-4 of the General Laws in Chapter 27-18.8 entitled "Health

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

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

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

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

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

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

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

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

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     (b) Dental services and treatment rendered to patients in Rhode Island shall be reimbursed

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by standards governed by the general laws of Rhode Island.

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     SECTION 2. Section 27-18-56 of the General Laws in Chapter 27-18 entitled "Accident

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and Sickness Insurance Policies" is hereby amended to read as follows:

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

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

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

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

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

 

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

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management decisions or utilization review provisions for any patient.

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     (b) Dental services and treatment rendered to patients in Rhode Island shall be reimbursed

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by standards governed by the general laws of Rhode Island.

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     SECTION 3. Section 27-20-49 of the General Laws in Chapter 27-20 entitled "Nonprofit

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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the service in question was rendered.

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     (b) Dental services and treatment rendered to patients in Rhode Island shall be reimbursed

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by standards governed by the general laws of Rhode Island.

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     SECTION 4. Section 27-20.1-3 of the General Laws in Chapter 27-20.1 entitled "Nonprofit

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

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     27-20.1-3. Contracts.

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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provisions for any patient.

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     (e) Dental services and treatment rendered to patients in Rhode Island shall be reimbursed

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by standards governed by the general laws of Rhode Island.

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     SECTION 5. 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 -- HEALTH CARE ACCESSIBILITY AND QUALITY

ASSURANCE ACT

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     This act would provide that dental services and treatment rendered to patients in Rhode

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Island would be reimbursed by standards governed by the general laws of Rhode Island.

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     This act would take effect upon passage.

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