Bill > H5045

This bill establishes new regulations for "dental leased networks," which are arrangements where an entity (a "Provider Network Entity") contracts with dentists ("Participating Dental Providers") and then makes access to these dentists available to other health plans ("Third-party Health Plans"). The bill mandates that Provider Network Entities must have written agreements with all participating dentists and, at the time of initial contracting, must provide dentists with a list of all Third-party Health Plans that will be accessing their network, identify which fee schedule will be used for each plan, and explain the Third-party Health Plan's credentialing and administrative procedures. Third-party Health Plans are required to reimburse dentists according to the specified fee schedules and must notify dentists in writing about which Provider Network Entity contract is being used for a particular dental benefit plan and the applicable fee schedule, including any changes. Additionally, Third-party Health Plans must clearly inform their customers that they are using leased networks and that they do not have direct contracts with the listed dentists, and that any disputes will be handled according to the agreement between the dentist and the Provider Network Entity. The Commissioner of Insurance will oversee these arrangements, requiring prior approval for Third-party Health Plans accessing these networks and can deny approval if the use of the network is deemed unreasonable in relation to median reimbursement fees, premiums charged, or if premiums are excessive, inadequate, or discriminatory.

Health and Social Services

Joint Committee on Financial Services (Joint)

https://malegislature.gov/Bills/194/H5045