Senate Bill 2273

AN ACT TO AMEND SECTION 83-51-3, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT AN INSURER SHALL NOT MAINTAIN A DENTAL PLAN THAT IS BASED ON A PROVIDER'S CONTRACTED FEE FOR COVERED SERVICES, OR THAT USES DOWNCODING OR BUNDLING IN A CERTAIN MANNER; TO REQUIRE AN INSURER TO ENSURE THAT AN EXPLANATION OF BENEFITS FOR A DENTAL PLAN INCLUDES THE REASON FOR ANY DOWNCODING OR BUNDING RESULTS; TO SET CERTAIN DEFINITIONS RELATED TO THE ACT; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. Section 83-51-3, Mississippi Code of 1972, is amended as follows:

83-51-3. (1) No health insurance policy or employee benefit plan which is delivered, renewed, issued for delivery, or otherwise contracted for in this state shall:

(a) Prevent any person who is a party to or beneficiary of any such health insurance policy or employee benefit plan from selecting the dentist of his choice to furnish the dental care services offered by such policy or plan, or interfere with such selection, provided the dentist selected is licensed to furnish such dental care services in this state;

(b) Deny any dentist the right to participate as a contracting provider for such policy or plan, provided the dentist is licensed to furnish the dental care services offered by such policy or plan;

(c) Authorize any person to regulate, interfere or intervene in any manner in the diagnosis or treatment rendered by a dentist to his patient for the purpose of preventing, alleviating, curing or healing dental illness or injury, provided such dentist practices within the scope of his license; or

(d) Require that any dentist furnishing dental care services make or obtain dental x-rays or any other diagnostic aids for the purpose of preventing, alleviating, curing or healing dental illness or injury; provided, however, that nothing herein shall prohibit requests for existing dental x-rays or any other existing diagnostic aids for the purpose of determining benefits payable under a health insurance policy or employee benefit plan.

Nothing in this chapter shall prohibit the predetermination of benefits for dental care expenses prior to treatment by the attending dentist.

(2) An insurer shall not maintain a dental plan that:

(a) Is based on the provider's contracted fee for covered services;

(b) Uses downcoding in a manner that prevents a dental provider from collecting the fee for the actual service performed from either the plan or the patient; or

(c) Uses bundling in a manner where a procedure code is labeled as nonbillable to the patient unless, under generally accepted practice standards, the procedure code is for a procedure that may be provided in conjunction with another procedure.

(3) An insurer shall ensure that an explanation of benefits for a dental plan includes the reason for any downcoding or bundling result.

(4) As used in this section:

(a) "Bundling" means the practice of combining distinct dental procedures into one procedure for billing purposes.

(b) "Dental plan" means the same as that term is defined in Section 83-51-31.

(c) "Downcoding" means the adjustment of a claim submitted to a dental plan to a less complex or lower cost procedure code.

(d) "Covered services" means the same as that term is defined in Section 83-51-31.

(e) "Material change" means a change to:

(i) A dental plan's rules, guidelines, policies or procedures concerning payment for dental services;

(ii) The general policies of the dental plan that affect a reimbursement paid to providers; or

(iii) The manner by which a dental plan adjudicates and pays a claim for services.

SECTION 2. This act shall take effect and be in force from and after July 1, 2024.