HB 370

Bill Subjects

Abstract

Create new sections of Subtitle 17C of KRS Chapter 304 to define terms; permit third-party access to provider network contracts if certain conditions are met; prohibit a dental carrier from canceling or otherwise ending a contractual relationship with a provider that opts out of third-party access; require a dental carrier to accept a qualified provider regardless of whether the provider opts out of third-party access; provide that a provider shall not be bound by third-party access granted in violation of the relevant provisions; establish exceptions to the third-party access provisions; allow a dental benefit plan to deny a claim for procedures included in a prior authorization when certain conditions are met; establish requirements for payments from the dental benefit plan to the dentist; require an insurer of a dental benefit plan to honor an assignment of benefits and make payments directly to the dentist or professional dental service corporation when certain conditions are met; permit a dentist or professional dental service corporation with a valid assignment of benefits to bill the insurer and notify the insurer of the assignment; require the dentist or professional dental service organization to provide the assignment of benefits to the insurer upon request; allow an assignment of benefits to be revoked when certain conditions are met; require the insurer of a dental benefit plan to send a revocation to the dentist or professional dental service corporation; establish the effective date of a revocation; require a dentist or professional dental service corporation to reimburse an insured under certain circumstances; prohibit provisions relating to third-party access, prior authorization, and assignment of benefits from being waived by contract; create a new section of Subtitle 17A of KRS Chapter 304 to require an insurer and its health insurance plans to comply with the provisions relating to third-party access, prior authorization, and assignment of benefits; amend KRS 304.17C-085 to define terms; prohibit a provider from charging more than the provider's rate for noncovered services under a limited health service benefit plan; prohibit the amount of a contractual discount for covered services from resulting in a fee less than the limited health service benefit plan would pay but for certain contractual limitations; require reimbursement by a limited health service benefit plan to be reasonable and prohibit nominal reimbursement in order to claim services are covered; amend KRS 304.17A-611 to require retrospective denials of dental services to comply with the new section on prior authorization; amend KRS 222.422 to conform; permit the commissioner of insurance to promulgate regulations.