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STATE OF IOWA
KIM REYNOLDS
GOVERNOR
May 1, 2025
The Honorable Paul Pate
Secretary of State of Iowa
State Capitol
Des Moines, Iowa 50319
Dear Mr. Secretary,
I hereby transmit:
Senate File 470, an Act relating to prior authorization for dental care services, notice to
dental care providers that a dental care service plan is state- regulated, and the recovery of
overpayments by a dental carrier.
The above Senate File is hereby approved on this date.
SinqFrely,
Governor of Iowa
cc: Secretary of the Senate
Clerk of the House
STATE CAPITOL DES MOINES, IOWA 50319 515.281.5211 FAX 515.725.3527 WWW.GOVERNOR.IOWA.GOV
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Senate File 470
AN ACT
RELATING TO PRIOR AUTHORIZATION FOR DENTAL CARE SERVICES,
NOTICE TO DENTAL CARE PROVIDERS THAT A DENTAL CARE SERVICE
PLAN IS STATE- REGULATED, AND THE RECOVERY OF OVERPAYMENTS BY
A DENTAL CARRIER.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
Section 1. NEW SECTION. 514C.3D Prior authorization for
dental care services.
1. Definitions, As used in this section unless the context
otherwise provides:
a, " Commissioner - means the commissioner of insurance.
b, " Covered person"" means the same as defined in section
514C.3C.
C. Dental care provider"" means the same as defined in
section 514C.3C.
d, Dental care service plan - means the same as defined in
section 514C.3C.
e. ' Dental care services" means the same as defined in
section 514C.3C.
f, Dental carrier - means the same as defined in section
514C.3C.
g, ' Prior authorization - means a determination by a dental
carrier in response to a request submitted by a dental care
provider as to whether a specific dental care service proposed
by the dental care provider for a covered person will be
Senate File 470, p. 2
reimbursed at a specified amount, subject to any applicable
coinsurance or deductible required under the covered person's
dental care service plan.
2. Prior authorization,
a. A dental carrier shall not deny a claim submitted by a
dental care provider for dental care services approved by prior
authorization.
b. A dental carrier shall reimburse a dental care provider
at the contracted reimbursement rate for a dental care service
provided by the dental care provider to a covered person per
a prior authorization.
3. Exceptions. Subsection 2 shall not apply if any of the
following apply for each dental care service for which a dental
care provider is denied reimbursement:
a. On the date that the dental care service was provided
by the dental care provider to the covered person per a
prior authorization, a benefit limitation including but not
limited to an annual maximum or a frequency limitation that
was not applicable at the time of the prior authorization had
been reached due to utilization of the dental care service
plan subsequent to the dental carrier issuing the prior
authorization.
b. The dental care provider submits a claim for dental care
services approved by prior authorization and the documentation
of dental care services fails to support the claim for
dental care services as originally authorized by the prior
authorization.
c. Subsequent to the issuance of a prior authorization, and
prior to the provision of dental care services authorized by
the prior authorization, a covered person receives additional
dental care services, or a change in the dental condition of
the covered person occurs, such that the dental care services
authorized by the prior authorization are no longer considered
medically necessary based on the prevailing standard of care.
d. Subsequent to the issuance of a prior authorization, and
prior to the provision of dental care services authorized by
the prior authorization, a covered person receives additional
dental care services, or a change in the dental condition
Senate File 470, p. 3
of the covered person occurs, such that on the date that
the dental care service is to be provided a request for
prior authorization of the dental care service would require
disapproval pursuant to the terms and conditions for coverage
under the covered person's current dental care service plan.
e. A payor other than the dental carrier is responsible for
payment for the dental care service.
f. A dental care provider has already received payment from
the dental carrier for the dental care services identified in
the claim for reimbursement.
g. The claim was submitted fraudulently to the dental
carrier.
h. The dental care provider, covered person, or other
person not related to the dental carrier provided inaccurate
information that the dental carrier relied on, in whole
or in part, for the dental carriers prior authorization
determination.
i. On the date that the dental care service was provided by
the dental care provider to the covered person per the prior
authorization, the covered person was ineligible to receive the
dental care service and the dental carrier did not know, and
with the exercise of reasonable care could not have known, of
the covered person's ineligibility.
j. Prior to providing a dental care service approved by
prior authorization, the dental care provider terminated
participation in the dental carrier's network under which the
dental carrier issued the prior authorization for such dental
care service.
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.
5. Rules. The commissioner may adopt rules pursuant to
chapter 17A to administer this section.
Sec. 2. NEW SECTION. 514C.3E State- regulated dental care
service plans.
1. As used in this section, unless the context otherwise
provides:
a. " Commissioner - means the commissioner of insurance.
b. " Covered person"" means the same as defined in section
Senate File 470, p. 4
514C.3C.
C. " Dental care provider"" means the same as defined in
section 514C.3C.
d. " Dental care service plan - means the same as defined in
section 514C.3C.
e. ' Dental carrier"" means the same as defined in section
514C.3C.
2.
to the
to the
do all
a .
dental
means,
If a covered person's dental care service plan is subject
insurance laws and regulations of this state, or subject
jurisdiction of the commissioner, a dental carrier shall
of the following:
Disclose to a dental care provider through an online
care provider portal, or other easily accessible
that a covered person's dental care service plan is
state- regulated.
b. Include the statement e state- regulated"" on an electronic
or physical identification card issued to a covered person on
or after July 1, 2025.
3. Waiver prohibited. The requirements of this section
shall not be waived by contract. Any contract contrary to this
section shall be null and void.
4. Rules. The commissioner may adopt rules pursuant to
chapter 17A to administer this section.
Sec. 3. NEW SECTION. 514C.3F Dental carrier — recovery of
claim overpayment.
1. Definitions. As used in this section, unless the context
otherwise provides:
a. ' Dental care provider" means the same as defined in
section 514C.3C.
b. ' Dental care services - means the same as defined in
section 514C.3C.
C. " Dental carrier - means the same as defined in section
514C.3C.
d. " Overpayment" means a payment made in error by a dental
carrier to a dental provider for a dental care service.
2. Appeals. A dental carrier shall establish written
policies and procedures for a dental care provider to appeal
an overpayment recovery or overpayment recovery request made
by the dental carrier. The dental carrier shall notify the
Senate File 470, p. 5
dental care provider of the policies and procedures to appeal
an overpayment recovery or overpayment recovery request at the
time that the dental carrier makes the overpayment recovery or
overpayment recovery request. The policies and procedures must
allow a dental care provider to appeal an overpayment recovery
or overpayment recovery request within a minimum of ninety
calendar days after the dental care provider receives such
notice. The policies and procedures must allow the dental care
provider to access the claim information that is the subject of
the overpayment dispute.
3. Notice. A dental carrier shall not attempt to recover
an overpayment, in whole or in part, unless the dental
carrier provides written notice of the overpayment to the
dental care provider no later than three hundred sixty-five
calendar days after the date the dental care provider received
the overpayment. The written notice of overpayment must
identify the error made in the processing or payment of the
claim. The written notice must state a request for recovery
of the overpayment or notify the dental care provider of
withholding or reducing a payment as required in subsection
4. If a recovery attempt is made pursuant to subsection 4,
then the dental carrier shall be deemed to have met the notice
requirements of this subsection.
4. Withholding or reducing payments, A dental carrier may
attempt to recover an overpayment by withholding or reducing a
payment to a dental care provider for a different claim if the
dental carrier provides the dental care provider with written
notice within twenty-eight calendar days after the date of
withholding or reducing the payment for the other claim. The
notice must identify the original claim that was overpaid,
the amount being withheld or reduced for the overpayment and
recovery, and the payment from which such amount is being
withheld or reduced. A dental carrier may include the notice
required by this subsection as part of the notice required by
subsection 3.
5. Applicability. Subsections 3 and 4 shall not apply, and
a dental carrier shall be entitled to recover an overpayment,
if the overpayment recovery efforts are based on a reasonable
belief of fraud, abuse, or other intentional misconduct.
Senate File 470, p. 6
6. Waiver prohibited. The requirements of this section
shall not be waived by contract. Any contract contrary to this
section shall be null and void.
7. Rules. The commissioner of insurance may adopt rules
pursuant to chapter 17A to administer this section.
PAT GRASSLEY
President of the Senate Speaker of the . use
I hereby certify that this bill originated in the Senate and
is known as Senate File 470, Ninety-first General Assembly.
M I Approved , 2025
W W. CHARLES SMITHSON
Secr-tary ._• L he Senate
KIM ' EYNOLDS
Governor