Connecticut 2021 Regular Session Status: Enacted Bipartisan · 4 D · 1 R cosponsors

HB 6589 — AN ACT CONCERNING THIRD-PARTY ACCESS TO PARTICIPATING DENTAL PROVIDER CONTRACTS.

Last action — SIGNED BY GOVERNOR

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  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed House
  4. ✓
    Passed Senate
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced March 04, 2021. Enacted.

Prognosis

Likely to advance 78% · moderate confidence

Where this bill stands today.

Odds of enactment

High

How often bills like it became law.

  • Enacted

    Current position in the legislative process.

  • 6 sponsors

    6 primary, 0 co-sponsors signed on.

  • Bipartisan support

    Sponsored across 2 parties (4 D · 1 R) — cross-party backing.

Prognosis reads this bill's own signals — stage, sponsorship breadth, committee status, recorded votes and cross-state momentum. Odds come from a model trained on which bills have become law.

Bill Text

What changed in the latest version

266 added · 412 removed

Plain-language change summary

The recent amendments to Substitute House Bill No. 6589 primarily involve the definitions of certain key terms related to insurance regulations. These changes clarify the meanings of "affiliate," "alien insurer," and "annuities," ensuring that these definitions are precise and aligned with industry standards. This matters because having clear definitions helps both insurers and consumers understand their rights and responsibilities, promoting transparency and better regulatory compliance in the insurance market.

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House of Representatives General Assembly File No.
Substitute House Bill No.
345 January Session, 2021 Substitute House Bill No.
6589 Public Act No.
6589 House of Representatives, April 8, 2021 The Committee on Insurance and Real Estate reported through REP.
21-187 AN ACT CONCERNING THIRD-PARTY ACCESS TO PARTICIPATING DENTAL PROVIDER CONTRACTS.
WOOD, K.
ofthe29thDist., Chairperson oftheCommittee on the part of the House, that the substitute bill ought to pass.
AN ACT CONCERNING THIRD-PARTY ACCESS TO PARTICIPATING DENTAL PROVIDER CONTRACTS.
(3) "Annuities" means all agreements to make periodical payments sHB6589 / File No.
(3) "Annuities" means all agreements to make periodical payments where the making or continuance of all or some of the series of the payments, or the amount of the payment, is dependent upon the continuance of human life or is for a specified term of years.
345 1 sHB6589 File No.
This definition does not apply to payments made under a policy of life Substitute House Bill No.
345 where the making or continuance of all or some of the series of the payments, or the amount of the payment, is dependent upon the continuance of human life or is for a specified term of years.
6589 insurance.
This definition does not apply to payments made under a policy of life insurance.
For purposes of this subdivision "liabilities" shall include but not be limited to reserves required by statute or by regulations adopted by the commissioner in accordance with the provisions of chapter 54 or sHB6589 / File No.
For purposes of this subdivision "liabilities" shall include but not be limited to reserves required by statute or by regulations adopted by the commissioner in accordance with the provisions of chapter 54 or specific requirements imposed by the commissioner upon a subject Public Act No.
345 2 sHB6589 File No.
21-187 2 of 10 Substitute House Bill No.
345 specific requirements imposed by the commissioner upon a subject company at the time of admission or subsequent thereto.
6589 company at the time of admission or subsequent thereto.
(15) "Mutual insurer" means any insurer without capital stock, the managing directors or officers of which are elected by its members.
(15) "Mutual insurer" means any insurer without capital stock, the Public Act No.
sHB6589 / File No.
21-187 3 of 10 Substitute House Bill No.
345 3 sHB6589 File No.
6589 managing directors or officers of which are elected by its members.
345 (16) "Person" means an individual, a corporation, a partnership, a limited liability company, an association, a joint stock company, a business trust, an unincorporated organization or other legal entity.
(16) "Person" means an individual, a corporation, a partnership, a limited liability company, an association, a joint stock company, a business trust, an unincorporated organization or other legal entity.
(3) "Dental office" means a dental office, or an office, laboratory or operation or consultation room in which dental medicine, dental surgery or dental hygiene is carried on as a portion of such office's, laboratory's or room's regular business, that is owned or operated by a dentist who, or a professional corporation organized and existing under chapter 594a of the general statutes for the purpose of rendering sHB6589 / File No.
(3) "Dental office" means a dental office, or an office, laboratory or operation or consultation room in which dental medicine, dental Public Act No.
345 4 sHB6589 File No.
21-187 4 of 10 Substitute House Bill No.
345 professional dental services that, is authorized to own or operate such office, laboratory or room under section 20-122 of the general statutes;
6589 surgery or dental hygiene is carried on as a portion of such office's, laboratory's or room's regular business, that is owned or operated by a dentist who, or a professional corporation organized and existing under chapter 594a of the general statutes for the purpose of rendering professional dental services that, is authorized to own or operate such office, laboratory or room under section 20-122 of the general statutes;
(9) "Participating dental provider contract" means a contract between a health carrier, or the health carrier's contractor or subcontractor, and a participating dental provider under which the participating dental provider agrees to provide dental services tothe health carrier's covered persons, with an expectation of receiving payment or reimbursement directly or indirectly from the health carrier, other than coinsurance, sHB6589 / File No.
Public Act No.
345 5 sHB6589 File No.
21-187 5 of 10 Substitute House Bill No.
345 copayments or deductibles;
6589 (9) "Participating dental provider contract" means a contract between a health carrier, or the health carrier's contractor or subcontractor, and a participating dental provider under which the participating dental provider agrees to provide dental services tothe health carrier's covered persons, with an expectation of receiving payment or reimbursement directly or indirectly from the health carrier, other than coinsurance, copayments or deductibles;
(A) A health carrier and an intermediary or a participating dental provider shall allow a third party to gain access to such participating dental provider contract, except the health carrier may permit a third party to gain access to such participating dental provider contract if, at the time the health carrier allows the third party to gain access to such participating dental provider contract, the health carrier allows each participating dental provider that is a party to such participating dental provider contract to:
(A) A health carrier and an intermediary or a participating dental provider shall allow a third party to gain access to such participating dental provider contract, except the health carrier may permit a third party to gain access to such participating dental provider contract if, not later than thirty days after the contract permitting such third-party access is executed, renewed or amended or a later date mutually agreed to by the health carrier and such third party, the health carrier allows each participating dental provider that is a party to such participating dental provider contract to:
(i) Decline to participate in such third party's access to such participating dental provider contract;
(i) Decline to participate in such third party's access to such participating dental provider contract, which declination shall not, in and of itself, constitute grounds for the health carrier to terminate or cancel such participating dental provider contract;
or (ii) If such third party is a health carrier that gains access to such participating dental provider contract by leasing or purchasing such participating dental provider contract, contract with such third party;
or Public Act No.
21-187 6 of 10 Substitute House Bill No.
6589 (ii) Contract directly with such third party if such third party is a health carrier;
(I) Provides that the health carrier, or the health carrier's contractor sHB6589 / File No.
(I) Provides that the health carrier, or the health carrier's contractor or subcontractor, may enter into such contract with a third party and grant such access to a third party, and such third party may obtain the rights and responsibilities of such health carrier, or such health carrier's contractor or subcontractor, as if such third party were such health carrier, or such health carrier's contractor or subcontractor;
345 6 sHB6589 File No.
345 or subcontractor, may enter into such contract with a third party and grant such access to a third party, and such third party may obtain the rights and responsibilities of such health carrier, or such health carrier's contractor or subcontractor, as if such third party were such health carrier, or such health carrier's contractor or subcontractor;
(iii) The health carrier, or the health carrier's contractor or subcontractor, discloses, in writing or by electronic means, to each participating dental provider under such participating dental provider contract the identity of such third party on the date that the health carrier, or the health carrier's contractor or subcontractor, enters into a contract with such third party to allow such third party to gain access to such participating dental provider contract;
(iii) The health carrier, or the health carrier's contractor or subcontractor, discloses, in writing or by electronic means, to each participating dental provider under such participating dental provider contract the identity of such third party on the date that the health carrier, or the health carrier's contractor or subcontractor, enters into a contract with such third party to allow such third party to gain access to Public Act No.
21-187 7 of 10 Substitute House Bill No.
6589 such participating dental provider contract;
sHB6589 / File No.
(v) The health carrier, or the health carrier's contractor or subcontractor, requires such third party to identify the source of any discount provided under such participating dental provider contract on each remittance advice or explanation of payment under which such third party takes such discount, except no such identification shall be required for an electronic transaction required under the Health Insurance Portability and Accountability Act of 1996, P.L.
345 7 sHB6589 File No.
345 (v) The health carrier, or the health carrier's contractor or subcontractor, requires such third party to identify the source of any discount provided under such participating dental provider contract on each remittance advice or explanation of payment under which such third party takes such discount, except no such identification shall be required for an electronic transaction required under the Health Insurance Portability and Accountability Act of 1996, P.L.
(vi) If the health carrier, or the health carrier's contractor or subcontractor, intends to terminate such participating dental provider contract, the health carrier, or the health carrier's contractor or subcontractor, sends a written notice to such third party disclosing such intended termination not later than thirty days before the intended termination date;
(vi) If the health carrier, or the health carrier's contractor or subcontractor, intends to terminate such participating dental provider contract, the health carrier, or the health carrier's contractor or subcontractor, sends a written notice to such third party disclosing such intended termination;
and (viii) The health carrier, or the health carrier's contractor or subcontractor, provides a copy of such participating dental provider contract to any participating dental provider under such participating dental provider contract not later than thirty days after such participating dental provider submits a request to the health carrier, or the health carrier's contractor or subcontractor, for such copy.
and (viii) The health carrier, or the health carrier's contractor or Public Act No.
21-187 8 of 10 Substitute House Bill No.
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6589 subcontractor, provides a copy of such participating dental provider contract to any participating dental provider under such participating dental provider contract not later than thirty days after such participating dental provider submits a request to the health carrier, or the health carrier's contractor or subcontractor, for such copy.
(3) No health carrier, and no health carrier's contractor or subcontractor, shall refuse to enter into a participating dental provider contract with a dentist or dental office because the dentist or dental office declines to participate in a third party's access to the participating dental provider contract.
sHB6589 / File No.
(1) To a health carrier or other entity operating in accordance with the same brand licensee program as the health carrier, or the health carrier's contractor or subcontractor, that is a party to the participating dental provider contract;
345 8 sHB6589 File No.
345 (1) To a health carrier or other entity operating in accordance with the same brand licensee program as the health carrier, or the health carrier's contractor or subcontractor, that is a party to the participating dental provider contract;
or (3)For dental servicesprovidedto beneficiariesinthis state under the Medicaid program under Title XIX of the Social Security Act, as amendedfromtime totime, ortheChildren'sHealthInsurance Program (CHIP) under Title XXI of the Social Security Act, as amended from time to time.
or (3)For dental servicesprovidedto beneficiariesinthis state under the Public Act No.
(d) The commissioner may adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, to implement the provisions of this section.
21-187 9 of 10 Substitute House Bill No.
This act shall take effect as follows and shall amend the following sections:
6589 Medicaid program under Title XIX of the Social Security Act, as amendedfromtime totime, ortheChildren'sHealthInsurance Program (CHIP) under Title XXI of the Social Security Act, as amended from time to time.
Section 1 January 1, 2022 38a-1 Sec.
Approved July 13, 2021 Public Act No.
2 January 1, 2022 New section Statement of Legislative Commissioners:
21-187 10 of 10
In Section 2(a)(3), "service" was deleted for accuracy.
INS Joint Favorable Subst.
sHB6589 / File No.
345 9 sHB6589 File No.
345 The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose.
In general, fiscal impacts are based upon a variety of informational sources, including the analyst’s professional knowledge.
Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.
OFA Fiscal Note State Impact:
None Municipal Impact:
None Explanation The bill does not result in a fiscal impact to the state or municipalities as it regards certain requirements for contracting between private entities.
The Out Years State Impact:
None Municipal Impact:
None sHB6589 / File No.
345 10 sHB6589 File No.
345 OLR Bill Analysis sHB 6589 AN ACT CONCERNING THIRD-PARTY ACCESS TO PARTICIPATING DENTAL PROVIDER CONTRACTS.
SUMMARY This bill prohibits the parties to dental provider contracts from allowing third-party access to the contract (i.e., the health carrier’s dental network) unless the third party meets certain requirements.
It also allows participating dental providers to decline to participate in third-party access if these parties grant a third party access to the contract in violation of the bill’s provisions.
The bill applies to contracts entered, amended, or renewed on or after January 1, 2022.
The bill defines the various parties to these contracts and the contractsthemselves.Italsoallowstheinsurancecommissionertoadopt implementing regulations and makes a conforming change.
EFFECTIVE DATE:
January 1, 2022 DEFINITIONS Under the bill, a “participating dental provider” is a dentist or dental office providing services to patients under a participating dental provider contract.
A “participating dental provider contract” is a contract between a participating dental provider and a carrier or its contractor or subcontractor, in which the provider agrees to provide services to people the carrier covers with an expectation that the carrier pays or reimburses him or her, excluding cost-sharing paid by the patients themselves (i.e., copayments, coinsurance, or deductibles).
A “health carrier” is an insurer, HMO, hospital or medical service corporation, or certain other entities that pay for or reimburse health service costs or provide health insurance plans or benefits.
sHB6589 / File No.
345 11 sHB6589 File No.
345 A “third party” is a person that contracts with a health carrier or its contractors or subcontractors to gain access to dental services or discounts provided under a participating dental provider contract, but it excludes an employer or other group that the health carrier (or its contractors or subcontractors) administers.
A “dental office” is a dental office, or an office, laboratory, or operation or consultation room (1) in which dental medicine, dental surgery, or dental hygiene is regularly performed in the course of business and (2) that is owned or operated by a dentist or professional service corporation legally allowed to own or operate it.
CONTRACTS BETWEEN A HEALTH CARRIER AND AN INTERMEDIARY OR PARTICIPATING DENTAL PROVIDER The bill prohibits participating dental provider contracts between a health carrier and an intermediary (i.e., a person authorized to negotiate and execute these contracts on behalf of dentists, or dental offices or networks) or participating dental provider from allowing a third party to gain access to the participating dental provider contract.
However, it allows the health carrier to grant a third party access if it simultaneously allows each participating dental provider that is a party to the contract to (1) decline to participate in third-party access to the contract or (2) contract with the third party if it gained access to the contract by leasing or purchasing it.
CONTRACTS BETWEEN PARTICIPATING DENTAL PROVIDERS OR INTERMEDIARIES AND HEALTH CARRIERS The bill also prohibits contracts between a participating dental provider or an intermediary and a health carrier (or its contractors or subcontractors) from allowing the health carrier or its contractors or subcontractors from contracting with a third party that allows the third party to gain access to the participating dental provider contract.
However, it allows this access if the participating dental provider contract:
1.
allows the health carrier or its contractors or subcontractors to contract with a third party and grants it access, and allows the sHB6589 / File No.
345 12 sHB6589 File No.
345 third party to obtain the health carrier’s rights and responsibilities as if it were the health carrier or its contractors or subcontractors, as applicable;
2.
clearly identifies the provisions allowing the health carrier, or its contractor or subcontractor, to grant third-party access;
and 3.
allows a participating dental provider to decline to participate in third-party access.
It also places the following requirements on these participating dental provider contracts that allow health carrier to grant access to a third party:
1.
the third party must comply with all terms of the contract;
2.
the health carrier (or its contractor or subcontractor) must disclose electronically or in writing the third party’s identity to each participating dental provider under the contract on the date it contracts with it for access;
3.
the health carrier (or its contractor or subcontractor) must (a) make publicly available on its website a list containing the name of every third party with which it contracts that is granted access to the participating dental provider contract and (b) update it at least every 90 days;
4.
thehealth carrier (or itscontractor or subcontractor)must require a third party to identify the source of any discount provided under the contract on each remittance advice or explanation of payment under which the third party takes this discount, excluding electronic transactions required by the federal Health Insurance Portability and Accountability Act;
5.
a health carrier (or its contractor or subtractor) intending to end a participating provider contract must notify a third party in writing at least 30 days before the contract termination date, with the third party’s right to a discounted rate under the contract sHB6589 / File No.
345 13 sHB6589 File No.
345 ending when the contract does;
and 6.
the health carrier (or its contractor or subcontractor) must provide a copy of a participating provider contract to any participating dental provider within 30 days of request.
EXEMPTIONS The bill exempts from its provisions any contract that grants the following entities access to a participating dental provider contract:
1.
a health carrier or other entity operating in accordance with the health carrier’s (or contractor’s or subcontractor’s) brand licensee program when the health carrier or other entity is a party to the provider contract (the bill does not define “brand licensee program”);
2.
a health carrier’s (or contractor’s or subcontractor’s) affiliate that is a party to the dental provider contract, if the health carrier, contractor, or subcontractor makes a list of affiliates publicly available on their website;
or 3.
dental servicesprovidedto Medicaidbeneficiariesor throughthe Children’s Health Insurance Program (CHIP).
COMMITTEE ACTION Insurance and Real Estate Committee Joint Favorable Substitute Yea 18 Nay 0 (03/22/2021) sHB6589 / File No.
345 14
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Action History

  1. SIGNED BY GOVERNOR

  2. TRANSMITTED BY SECRETARY OF THE STATE TO GOVERNOR

  3. TRANSMITTED TO SECRETARY OF THE STATE

  4. PUBLIC ACT 21-187

  5. IN CONCURRENCE

  6. SEN. PASSED, HO. AMEND. SCH. A

  7. SEN. ADOPTED HO. AMEND. SCH. A

  8. SENATE CALENDAR NUMBER 567

  9. FAV. RPT., TAB. FOR CAL., SEN.

  10. TRANSMITTED PURSUANT TO JOINT RULE 17

  11. HOUSE PASSED, HOUSE AMEND. SCH. A

  12. HOUSE ADOPTED HOUSE AMEND. SCH. A

  13. FILE NO. 345

  14. HOUSE CALENDAR NUMBER 261

  15. FAV. RPT., TABLED FOR HOUSE CALENDAR

  16. RPTD. OUT OF LCO

  17. REFERRED TO Office of Legislative Research AND Office of Fiscal Analysis 04/07/21

  18. FILED WITH LCO

  19. Joint Favorable Substitute

  20. PUBLIC HEARING 0318

  21. REF. TO JOINT COMM. ON Insurance and Real Estate

Sponsors

Sponsorship breakdown

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6 sponsors · 0 co-sponsors · 181 not signed on

Sponsors (6)

Co-sponsors (0)

None.

Not signed on (181)

181 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

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Subjects

healthcare health-insurance
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Frequently asked questions

Who sponsors HB 6589?
HB 6589 is sponsored by Tom Delnicki (Republican), Jaime S. Foster (Democratic), Derek Slap (Democratic), Michael D. Quinn (Democratic), Daugherty Abrams, Mary, and Kenneth Gucker (Democratic).
What is the current status of HB 6589?
This bill has been enacted into law. Introduced March 04, 2021. Enacted.
Where can I track HB 6589?
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