Bill > SF470

This bill introduces three key provisions related to dental care services in Iowa. First, it establishes rules for prior authorization, requiring dental carriers to reimburse dental care providers for services that have been pre-approved, with several specific exceptions where reimbursement might be denied, such as when benefit limitations have been reached, documentation is insufficient, or the patient's condition has changed. Second, the bill mandates that dental carriers disclose when a dental care service plan is state-regulated, including displaying a "state-regulated" statement on patient identification cards and through online provider portals. Third, the bill creates new regulations around how dental carriers can recover overpayments, requiring them to provide written notice within 365 days of an overpayment, establish clear appeal procedures for providers, and allow providers at least 90 days to appeal overpayment recovery requests. The bill prohibits waiving these requirements by contract and gives the Insurance Commissioner authority to create rules for implementing these provisions. These changes aim to increase transparency, protect dental care providers, and establish clearer guidelines for dental insurance practices, with an effective date of July 1, 2025.

Commerce (S)

https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=SF470