Creates provisions relating to dental plans

SECOND REGULAR SESSION
HOUSE BILL NO. 2471
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE F ARNAN.
5941H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o amend chapter 354, RSMo, by adding thereto one new section relating to dental plans.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 354, RSMo, is amended by adding thereto one new section, to be
2 known as section 354.718, to read as follows:
354.718. 1. As used in this section, the following terms mean:
2 (1) "Dental loss ratio", the per centage of the amount of premiums r eceived by a
3 dental plan expended on actual patient car e rather than overhead or administrative
4 costs, as determined by the following fraction:
5 (a) The numerator shall be the amount expended for clinical dental services
6 pr ovided to dental plan enro llees, including payments under capitation contracts with
7 dental pro viders, during the repo rting year together with unpaid claim r eserves for
8 dental services performed during the repo rting year but not yet paid. The numerator
9 shall not include:
10 a. Administrative costs including, but not limited to, infrastructur e costs,
11 personnel costs, or br oker payments;
12 b. Amounts paid to third-party vendors for secondary network savings;
13 c. Amounts paid to third-party vendors for network development,
1 4 administrative fees, claims pr ocessing, and utilization management;
15 d. Amounts paid to provi ders for pr ofessional or administrative services that do
16 not rep res ent compensation or r eimbursement for covered services pro vided to an
17 enr ollee including, but not limited to, dental record copying costs, attorney's fees,
18 subr ogation vendor fees, and compensation to paraprof essionals, janitors, quality
EXPLANA TION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
intended to be omitted from the law . Matter in bold-face type in the above bill is proposed language.
19 assurance analysts, administrative supervisors, secr etaries to dental personnel, and
20 dental r ecord clerks; or
21 e. Overpayments made by the provi der that wer e recover ed by the dental plan
22 and not pr eviously rep orted on any dental loss ratio report; and
23 (b) The denominator shall be all earned pr emiums rec eived by the dental plan
24 for dental services, excluding federal and state taxes; licensing fees; regu latory fees;
25 payments or r eceipts for risk adjustment, risk corridors, and r einsurance; community
26 benefit expenditures , as defined in 45 CFR 158.162(c); and any other payments r equir ed
27 by federal law;
28 (2) "Dental plan", any health benefit plan, or portion of a health benefit plan,
29 that issues, sells, renews, or offers a contract covering dental car e services. The term
30 "dental plan" shall not include any health benefit plan for health car e services under
31 MO HealthNet, the state children 's health insurance pr ogram authorized in sections
32 208.631 to 208.658, or any other state-sponsor ed health insurance pr ogram.
33 2. (1) A dental plan shall file with the department of commer ce and insurance a
34 dental loss ratio r eport for each calendar year during which the dental plan pr ovided
35 dental coverage containing the same information as r equir ed in the 2013 federal dental
36 loss ratio annual rep orting form (CMS-10418). All terms used in the dental loss ratio
37 annual rep ort shall have the same meanings as used in the federal Public Health Service
38 Act, 42 U.S.C. Section 300gg-18, and 45 CFR Part 158.
39 (2) The dental loss ratio rep ort shall be filed before Mar ch first of each year for
40 the pr evious calendar year . If the department of commer ce and insurance req uires data
41 verification of the dental loss ratio rep ort, it shall give the dental plan thirty days' notice
42 of the additional information and data requ ired to be submitted to the department. The
43 dental plan shall submit the information r equested within thirty days of such notice.
44 The department shall be deemed to have appr oved all dental loss ratio rep orts within
45 ninety days of the filing of the rep orts unless a dental plan is notified otherwise.
46 (3) The department of commer ce and insurance shall make available to the
47 public all the data pr ovided to the department in accordance with this section.
48 3. A dental plan shall pro vide an annual r ebate to each enr ollee, on a pr o rata
49 basis, to the extent the dental loss ratio is less than eighty-five per cent before August
50 first of the year following the year for which the dental loss ratio rep ort was issued. The
51 total annual r ebate is the excess revenu e expended by the dental plan on overhead or
52 administrative costs, as determined by the amount by which the denominator of the
53 dental loss ratio exceeds the numerator .
HB 2471 2
54 4. Any failur e to r ebate the amount prescribed in subsection 3 of this section by a
55 dental plan not req uired to be licensed by the department of commer ce and insurance
56 shall be deemed an unlawful practice under section 407.020.
✔
HB 2471 3