SB 269 — Revises provisions relating to dental insurance. (BDR 57-817)

(ReprintedSenate withBill amendmentsNo. adopted on May 20, 2021) FIRST REPRINT S.B.

269269–Senators SENATEKieckhefer; BILL NO .

269–SENATORSand KSeevers IECKHEFERGansert ;CHAPTER..........

AND SEEVERS G ANSERT M ARCH 17, 2021 ____________ Referred to Committee on Commerce and Labor SUMMARY—Revises provisions relating to dental insurance.

(BDR 57-817) FISCAL NOTE:

Effect on Local Government:

May have Fiscal Effect.

Effect on the State:

No.

~ EXPLANATION – Matter in bolded italics is new;

matter between brackets [omitted material] is material to be omitted.

Existing law imposes certain requirements relating to the operation of health 695Dbenefit ofplans NRS) Sections 2, 3 and 9stand-alone ofdental thisplans. bill define certain relevant terms.

(NRS 687B.470-687B.850, chapter 695D of NRS) Sections 2, 3 and 9 of this bill define certain relevant terms.

(1) provide(2) establish written noticeprocedures toby which a dentist ofmay anychallenge attemptsuch to recover an overpayment;attempt.

Sections 4 and (2)10 establishalso writtenprohibit proceduressuch byan whichinsurer aor dentistadministrator mayfrom challengeattempting suchto recover an attempt.overpayment more than 12 months after the date of the overpayment except in certain circumstances.

recoverSections an5 overpaymentand more11 thanof 12this monthsbill afterprohibit thea datedental insurer or an administrator of thean overpaymenttinginsurance toplan exceptthat inincludes certaindental coverage from circumstances.

Sections 56, 7 and 1112 of this bill prohibitmake aconforming dentalchanges insurerto orindicate anthe administratorplacement of ancertain insuranceprovisions planadded thatby includesthis dentalbill coveragein fromthe denyingNevada aRevised claimStatutes. for which preauthorization was granted except in certain circumstances.

Sections 6,13-15 7 and 12 of this bill make conforming changes to indicate the placementrequirements of certainsections provisions4 added by this bill in the Nevada and 5 applicable to dental benefits provided by employers, including the State and local governments.

-EXPLANATION *SB269_R1* – 2Matter –in THEbolded PEOPLEitalics OFis THEnew; STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

matter between brackets [omitted material] is material to be omitted.

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

A health carrier who provides dental coverage or any administrator who recovers overpayments under a health benefit plan that includes dental coverage shall provide written notice to a dentist of any attempt to recover an overpayment, other than- a81st duplicateSession (2021) – 2 – limitation:icate payment.

The notice must include, without limitation:(a) A description of the error that justifies the recovery;

(a) A description of the error that justifies the recovery;

- *SB269_R1* – 3 – Sec.

A health carrier who provides dental coverage or an administrator of a health benefit plan that includes dental coverage shall not refuse to pay a claim for dental care for which the health carrier or administrator, as applicable, has granted priorpri(a) authorizationA unless:limitation on coverage provided under the applicable health benefit plan, including, without limitation, a limitation on total costs or frequency of services:

(a) A limitation on coverage provided under the applicable health benefit plan, including, without limitation, a limitation on total costs or frequency of services:

and (2) Applied at the time of the provision of the dental care for which the prior authorization was granted because additional covered dental care was provided to the insured after the prior - 81st Session (2021) – 3 – care for which prior authorization was grantedgranted;ion andof beforethe dental (b) The documentation provided by the provisionperson ofsubmitting the dentalclaim careclearly fails to support the claim for which prior authorization was originally granted;

(b) The documentation provided by the person submitting the claim clearly fails to support the claim for which prior authorization was originally granted;

(e) The dentist has previously been paid for the procedures coveredcov(f) The claim was fraudulent or the prior authorization was based, in whole or in part, on materially false information provided by the claim;dentist or insured or another person who is not affiliated with the health carrier or administrator, as applicable;

(f) The claim was fraudulent or the prior authorization was based, in whole or in part, on materially false information provided by the dentist or insured or another person who is not affiliated with the health carrier or administrator, as applicable;

(a) “Medically necessary” means dental care that a prudent dentist would provide to a patient to prevent, diagnose or treat an - *SB269_R1* – 4 – illness, injury or disease, or any symptoms thereof, that is necessary and:

(1)standards Providedof indental accordancepractice;nce with generally accepted standards(2) ofClinically dentalappropriate practice;with regard to type, frequency, extent, location and duration;

(2) Clinically appropriate with regard to type, frequency, extent, location and duration;

and - 81st Session (2021) – 4 – (5) The most clinically appropriate level of dental care that may be safely provided to the patient.

(b) “Prior authorization” means any communication issued by a health carrier who provides dental coverage or an administrator of a health benefit plan that includes dental coverage in response to a request by a dentist in the form prescribed by the healthhealthonse carrier or administrator, as applicable, which indicates that specific dental care provided to an insured is:

As applicable, ensure that each contract entered into for the purposes of the network plan between a participating provider of health care and the health carrier complies with the requirements set forth in NRS 687B.600 to 687B.850, inclusive [;] , and sections 2 to 5, inclusive, of this act;

and850, inclusive [;] , and sections 2 to 3.

- *SB269_R1* – 5 – Sec.

and - 81st Session (2021) – 5 – (b) The date on which the dental care for which the overpayment was made was provided and the name of the insured to whom the dental care was provided.