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H. B. No. 1117 *HR43/R1920* ~ OFFICIAL ~ G1/2
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To: Insurance
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026
By: Representatives Zuber, Felsher,
Steverson, Shanks, McKnight, McLean, McCarty,
Owen, Hurst, McMillan, Turner, Bell (65th),
Burch, Ford (73rd), Horan, Varner, Remak,
Eure, Hall, Hawkins
HOUSE BILL NO. 1117
AN ACT TO BE KNOWN AS THE CREATING TRANSPARENCY AND 1
ACCOUNTABILITY IN DENTAL SERVICES ACT; TO REQUIRE DENTAL INSURANCE 2
CARRIERS TO PERFORM DENTAL LOSS RATIO CALCULATIONS AND FILE A 3
DENTAL LOSS RATIO ANNUAL REPORT WITH THE COMMISSIONER OF 4
INSURANCE; TO REQUIRE THE COMMISSIONER TO MAKE SUCH REPORTS 5
AVAILABLE TO THE PUBLIC ON THE WEBSITE FOR THE DEPARTMENT OF 6
INSURANCE; TO REQUIRE THE COMMISSIONER TO FILE A REPORT ON THE 7
DATA COLLECTED PURSUANT TO THE REPORTS SUBMITTED BY CARRIERS WITH 8
BOTH THE SENATE AND HOUSE INSURANCE COMMITTEES; AND FOR RELATED 9
PURPOSES. 10
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 11
SECTION 1. (1) This act shall be known and may be cited as 12
the "Creating Transparency and Accountability in Dental Services 13
Act". The purpose of this act is to provide for transparency and 14
accountability of the expenditures of dental health care service 15
plan premiums and to require annual reporting. 16
(2) For the purposes of this section, the following terms 17
have the meanings as defined in this subsection, unless the 18
context clearly indicates otherwise: 19
(a) "Commissioner" and "department" refer to the 20
Commissioner of Insurance and the Department of Insurance 21
respectively. 22
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(b) "Dental carrier" or "carrier" means a dental 23
insurance company, dental service corporation, dental plan 24
organization authorized to provide dental benefits, or a health 25
insurance plan that includes coverage for dental services. 26
(c) "Dental health care service plan" or "plan" means 27
any plan that provides coverage for dental health care services to 28
enrollees in exchange for premiums. 29
(d) "Dental loss ratio" or "DLR" means a percentage of 30
premium dollars spent on patient care as calculated pursuant to 31
this section. 32
(3) Dental loss ratio calculations are calculated by 33
dividing the numerator by the denominator as follows: 34
(a) The numerator shall be the amount spent on patient 35
care and shall include: 36
(i) The amount expended for clinical dental 37
services which are services within the code on dental procedures 38
and nomenclature, provided to enrollees which includes payments 39
under capitation contracts with dental providers, whose services 40
are covered by the contract for dental clinical services or 41
supplies covered by the contract, provided that any overpayment 42
that has already been received from providers shall not be 43
reported as a paid claim. Overpayment recoveries received from 44
providers shall be deducted from incurred claim amounts; 45
(ii) Unpaid claim reserves; and 46
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(iii) Claim payments recovered by insurers from 47
providers or enrollees using utilization management efforts, 48
deducted from claim amounts. 49
(b) Calculation of the numerator shall not include: 50
(i) All administrative costs, including, but not 51
limited to, infrastructure, personnel costs or broker payments; 52
(ii) Amounts paid to third-party vendors for 53
secondary network savings; 54
(iii) Amounts paid to third-party vendors for 55
network development, administrative fees, claims processing and 56
utilization management; and 57
(iv) Amounts paid to a provider for professional 58
or administrative services that do not represent compensation or 59
reimbursement for covered services to an enrollee, including, but 60
not limited to, dental record copying costs, attorney fees, 61
subrogation vendor fees, compensation to paraprofessionals, 62
janitors, quality assurance analysts, administrative supervisors, 63
secretaries to dental personnel and dental record clerks. 64
(c) The denominator is the total amount of earned 65
premium revenue except for federal and state taxes, licensing and 66
regulatory fees paid, and any other payments required by federal 67
law. 68
(4) (a) In order to provide transparency of patient premium 69
expenditures for dental health care services, all carriers that 70
renew, deliver or issue a dental health care service plan in this 71
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state shall file a dental loss ratio annual report for the 72
preceding calendar year with the commissioner no later than June 73
30, 2026, and annually thereafter, no later than June 30 of each 74
calendar year. 75
(b) The annual report shall: 76
(i) Be organized by market and product type; 77
(ii) Contain the same information as required by 78
the 2013 federal Centers for Medicare & Medicaid Services Medical 79
Loss Ratio Annual Reporting Form (CMS-10418); and 80
(iii) Provide the number of enrollees, the plan 81
cost-sharing, deductible amounts, the annual maximum coverage 82
limit, and the number of enrollees who meet or exceed the annual 83
coverage limit. 84
(c) Any terms used in the data loss ratio annual report 85
shall have the same meaning as used in the federal Public Health 86
Service Act, 42 USC Section 300gg-18, and Part 158 of Title 45 of 87
the Code of Federal Regulations. 88
(d) The data loss ratio annual report filed with the 89
commissioner shall be made available to the public no later than 90
December 1, 2026, and annually thereafter, no later than December 91
1 of each calendar year. The commissioner shall post the dental 92
loss ratio in a searchable format on the department's website. 93
(5) If the commissioner deems it necessary that additional 94
information is needed to verify a plan's representation of its 95
data, the commissioner shall provide a written notice to the 96
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ST: Creating Transparency and Accountability in
Dental Services Act; create to require annual
reporting.
carrier that requests this additional information. The carrier 97
shall have thirty (30) days from receipt of the notice to submit 98
the additional information. 99
(6) The commissioner shall file a report on the data 100
collected pursuant to this section with both the Senate and House 101
Insurance Committees no later than December 1, 2026, and annually 102
thereafter, no later than December 1 of each subsequent calendar 103
year. 104
(7) The provisions of this section shall not apply to 105
benefit plans under Medicaid, the Mississippi Children's Health 106
Insurance Program, or other state-sponsored plans. 107
SECTION 2. This act shall take effect and be in force from 108
and after its passage. 109