House Bill 1117

AN ACT TO BE KNOWN AS THE CREATING TRANSPARENCY AND ACCOUNTABILITY IN DENTAL SERVICES ACT; TO REQUIRE DENTAL INSURANCE CARRIERS TO PERFORM DENTAL LOSS RATIO CALCULATIONS AND FILE A DENTAL LOSS RATIO ANNUAL REPORT WITH THE COMMISSIONER OF INSURANCE; TO REQUIRE THE COMMISSIONER TO MAKE SUCH REPORTS AVAILABLE TO THE PUBLIC ON THE WEBSITE FOR THE DEPARTMENT OF INSURANCE; TO REQUIRE THE COMMISSIONER TO FILE A REPORT ON THE DATA COLLECTED PURSUANT TO THE REPORTS SUBMITTED BY CARRIERS WITH BOTH THE SENATE AND HOUSE INSURANCE COMMITTEES; AND FOR RELATED PURPOSES.

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

SECTION 1. (1) This act shall be known and may be cited as the "Creating Transparency and Accountability in Dental Services Act". The purpose of this act is to provide for transparency and accountability of the expenditures of dental health care service plan premiums and to require annual reporting.

(2) For the purposes of this section, the following terms have the meanings as defined in this subsection, unless the context clearly indicates otherwise:

(a) "Commissioner" and "department" refer to the Commissioner of Insurance and the Department of Insurance respectively.

(b) "Dental carrier" or "carrier" means a dental insurance company, dental service corporation, dental plan organization authorized to provide dental benefits, or a health insurance plan that includes coverage for dental services.

(c) "Dental health care service plan" or "plan" means any plan that provides coverage for dental health care services to enrollees in exchange for premiums.

(d) "Dental loss ratio" or "DLR" means a percentage of premium dollars spent on patient care as calculated pursuant to this section.

(3) Dental loss ratio calculations are calculated by dividing the numerator by the denominator as follows:

(a) The numerator shall be the amount spent on patient care and shall include:

(i) The amount expended for clinical dental services which are services within the code on dental procedures and nomenclature, provided to enrollees which includes payments under capitation contracts with dental providers, whose services are covered by the contract for dental clinical services or supplies covered by the contract, provided that any overpayment that has already been received from providers shall not be reported as a paid claim. Overpayment recoveries received from providers shall be deducted from incurred claim amounts;

(ii) Unpaid claim reserves; and

(iii) Claim payments recovered by insurers from providers or enrollees using utilization management efforts, deducted from claim amounts.

(b) Calculation of the numerator shall not include:

(i) All administrative costs, including, but not limited to, infrastructure, personnel costs or broker payments;

(ii) Amounts paid to third-party vendors for secondary network savings;

(iii) Amounts paid to third-party vendors for network development, administrative fees, claims processing and utilization management; and

(iv) Amounts paid to a provider for professional or administrative services that do not represent compensation or reimbursement for covered services to an enrollee, including, but not limited to, dental record copying costs, attorney fees, subrogation vendor fees, compensation to paraprofessionals, janitors, quality assurance analysts, administrative supervisors, secretaries to dental personnel and dental record clerks.

(c) The denominator is the total amount of earned premium revenue except for federal and state taxes, licensing and regulatory fees paid, and any other payments required by federal law.

(4) (a) In order to provide transparency of patient premium expenditures for dental health care services, all carriers that renew, deliver or issue a dental health care service plan in this state shall file a dental loss ratio annual report for the preceding calendar year with the commissioner no later than June 30, 2026, and annually thereafter, no later than June 30 of each calendar year.

(b) The annual report shall:

(i) Be organized by market and product type;

(ii) Contain the same information as required by the 2013 federal Centers for Medicare & Medicaid Services Medical Loss Ratio Annual Reporting Form (CMS-10418); and

(iii) Provide the number of enrollees, the plan cost-sharing, deductible amounts, the annual maximum coverage limit, and the number of enrollees who meet or exceed the annual coverage limit.

(c) Any terms used in the data loss ratio annual report shall have the same meaning as used in the federal Public Health Service Act, 42 USC Section 300gg-18, and Part 158 of Title 45 of the Code of Federal Regulations.

(d) The data loss ratio annual report filed with the commissioner shall be made available to the public no later than December 1, 2026, and annually thereafter, no later than December 1 of each calendar year. The commissioner shall post the dental loss ratio in a searchable format on the department's website.

(5) If the commissioner deems it necessary that additional information is needed to verify a plan's representation of its data, the commissioner shall provide a written notice to the carrier that requests this additional information. The carrier shall have thirty (30) days from receipt of the notice to submit the additional information.

(6) The commissioner shall file a report on the data collected pursuant to this section with both the Senate and House Insurance Committees no later than December 1, 2026, and annually thereafter, no later than December 1 of each subsequent calendar year.

(7) The provisions of this section shall not apply to benefit plans under Medicaid, the Mississippi Children's Health Insurance Program, or other state-sponsored plans.

SECTION 2. This act shall take effect and be in force from and after its passage.