AN ACT to amend and reenact section 26.1-47-02.1 of the North Dakota Century Code, relating to preferred provider arrangements and restrictions on dental care services.
Summary
SB 2377 amends North Dakota law governing preferred provider arrangements in dental plans. The bill defines “covered services” as dental care services for which a reimbursement is available under an enrollee’s plan, including services that would otherwise be reimbursable but for deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, or frequency limits. It then limits what a dental preferred provider arrangement may do with respect to fees for services that are not covered by the plan.
Under the bill, a preferred provider arrangement may not directly or indirectly set or regulate the fees charged by a preferred provider for dental services except for covered services. It also prohibits arrangements from restricting a covered person from receiving or paying for additional dental care services that the dental plan denied. If those additional services are provided, the patient may not be charged more than the contracted in-network rate for covered services unless the higher rate was disclosed before treatment. The bill therefore creates a consumer-protection rule for patients seeking noncovered or denied dental services from in-network providers.
Impact
The bill amends section 26.1-47-02.1 of the North Dakota Century Code, narrowing the ability of dental preferred provider arrangements to control provider pricing outside of covered services and adding disclosure and pricing protections for patients who choose to receive denied or additional dental care. Its practical effect is to limit contractual restrictions in dental network agreements and to protect patients from surprise charges above the contracted rate unless advance notice is given. The affected parties are dental insurers, preferred provider organizations, dentists, and covered persons enrolled in dental plans.
Sentiment
The bill appears to have broad bipartisan support and little visible opposition. It passed the Senate and House overwhelmingly, including unanimous House second reading approval and only one dissenting vote in the Senate on the later reading reflected in the record. The voting pattern suggests the measure was viewed as a consumer-friendly clarification of dental network rules rather than a controversial policy change.
Contention
No committee testimony or transcript discussion is provided, so specific points of debate are not available. Based on the text, any potential contention would likely center on whether the bill unduly limits insurer and network contract terms, versus whether it appropriately protects patients and preserves access to additional dental services when a plan denies coverage. Dental insurers and preferred provider arrangements would be the most likely parties to raise concerns, while patients and dental providers may favor the added flexibility and disclosure protections.
AN ACT to amend and reenact section 26.1-47-02.1 of the North Dakota Century Code, relating to preferred provider arrangements and restrictions on dental care services.
AN ACT to create and enact a new section to chapter 26.1-47 of the North Dakota Century Code, relating to method of dental payment options in preferred provider arrangements.
A BILL for an Act to create and enact a new section to chapter 23-12 of the North Dakota Century Code, relating to medical costs transparency for health care facilities; to amend and reenact section 26.1-47-02 of the North Dakota Century Code, relating to health care facility and preferred provider compliance with medical cost transparency requirements; and to provide a penalty.
AN ACT to create and enact a new section to chapter 43-28 of the North Dakota Century Code, relating to joint negotiations by dental providers with dental insurers.
AN ACT to create and enact a new section to chapter 23-27 and a new section to chapter 26.1-47 of the North Dakota Century Code, relating to ambulance service balanced billing and provider reimbursement; to amend and reenact section 23-27-04.8 of the North Dakota Century Code, relating to emergency medical services communication; to provide for a legislative management study; and to provide an appropriation.
Pharmacy benefits managers and prescription drug costs; to provide a penalty; to provide an appropriation; to provide for a transfer; to provide an effective date; to provide an expiration date; and to declare an emergency.