HOUSE DOCKET, NO. 4663        FILED ON: 11/26/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No.         

The Commonwealth of Massachusetts

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PRESENTED BY:

Angelo J. Puppolo, Jr.

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act relative to increasing patient choice through assignment of benefits.

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PETITION OF:

HOUSE DOCKET, NO. 4663        FILED ON: 11/26/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No.         

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-First General Court
(2019-2020)

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An Act relative to increasing patient choice through assignment of benefits.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Section 108B of chapter 175 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting at the end of said section the following new paragraph:-

Every carrier shall permit, as a provision in a group or individual policy, contract or health plan for coverage of dental services, a covered person to direct in writing that reimbursable benefits for covered dental services be paid directly to the treating dentist irrespective of whether the dentist has contracted with the carrier to provide dental services to covered persons of the carrier. The carrier paying the dentist, pursuant to a direction to pay duly executed by the covered person, shall have the right to review the records of the dentist receiving such payment that relate exclusively to that particular covered person and service provided pursuant to the claim for payment to determine that the service in question is rendered. The paying carrier shall not pay the dentist who has not contracted with the carrier a different rate or fee than a dentist who has contracted with the carrier for the same services rendered.

SECTION 2: Section 7 of chapter 176B of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting at the end thereof the following new paragraph:-

Every carrier, including but not limited to medical service corporations, shall permit, as a provision in a group or individual policy, contract or health plan for coverage of dental services, a covered person, including subscribers and covered dependents, to direct in writing that reimbursable benefits for covered dental services be paid directly to the treating dentist irrespective of whether the dentist has contracted with the carrier to provide dental services to covered persons of the carrier. The carrier paying the dentist, pursuant to a direction to pay duly executed by the covered person, shall have the right to review the records of the dentist receiving such payment that relate exclusively to that particular covered person and service provided pursuant to the claim for payment to determine that the service in question is rendered. The paying carrier shall not pay the dentist who has not contracted with the carrier a different rate or fee than a dentist who has contracted with the carrier for the same services rendered.

SECTION 3: Section 7 of chapter 176E of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting at the end thereof the following new paragraph:-

Every carrier, including but not limited to dental service corporations, shall permit, as a provision in a group or individual policy, contract or health plan for coverage of dental services, a covered person, including subscribers and covered dependents, to direct in writing that reimbursable benefits for covered dental services be paid directly to the treating dentist irrespective of whether the dentist has contracted with the carrier to provide dental services to covered persons of the carrier. The carrier paying the dentist, pursuant to a direction to pay duly executed by the covered person, shall have the right to review the records of the dentist receiving such payment that relate exclusively to that particular covered person and service provided pursuant to the claim for payment to determine that the service in question is rendered. The paying carrier shall not pay the dentist who has not contracted with the carrier a different rate or fee than a dentist who has contracted with the carrier for the same services rendered.

SECTION 4: Section 21 of chapter 176G of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after sub-section (d) the following sub-section:-

(e) Every carrier, including but not limited to health maintenance organizations, shall permit, as a provision in a group or individual policy, contract or health plan for coverage of dental services, a covered person, including members and enrolled members, to direct in writing that reimbursable benefits for covered dental services be paid directly to the treating dentist irrespective of whether the dentist has contracted with the carrier to provide dental services to covered persons of the carrier. The carrier paying the dentist, pursuant to a direction to pay duly executed by the covered person, shall have the right to review the records of the dentist receiving such payment that relate exclusively to that particular covered person and service provided pursuant to the claim for payment to determine that the service in question is rendered. The paying carrier shall not pay the dentist who has not contracted with the carrier a different rate or fee than a dentist who has contracted with the carrier for the same services rendered.

SECTION 5: Section 2 of chapter 176I of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting at the end thereof the following new paragraph:-

Every carrier, including but not limited to organizations, shall permit, as a provision in a group or individual policy, contract or health plan for coverage of dental services, a covered person to direct in writing that reimbursable benefits for covered dental services be paid directly to the treating dentist irrespective of whether the dentist has contracted with the carrier to provide dental services to covered persons of the carrier. The carrier paying the dentist, pursuant to a direction to pay duly executed by the covered person, shall have the right to review the records of the dentist receiving such payment that relate exclusively to that particular covered person and service provided pursuant to the claim for payment to determine that the service in question is rendered. The paying carrier shall not pay the dentist who has not contracted with the carrier a different rate or fee than a dentist who has contracted with the carrier for the same services rendered.