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SF 327

A bill for an act relating to dental provider reimbursement under the dental wellness plan and the dental wellness plan kids.

2025-2026 Regular Session Introduced by Molly Donahue and 3 co-sponsors

Align DWP and DWP Kids reimbursement with Hawki by paying the higher of UCR-based or billed charges, aiming to boost provider participation and member access.

Subcommittee: Klimesh, Costello, and Trone Garriott.
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Bill Summary · SF 327

Summary: S.F. 327 — Dental provider reimbursement under the Dental Wellness Plan and Dental Wellness Plan Kids

Overview

S.F. 327 seeks to adjust how dental providers are reimbursed for services delivered under Iowa’s Dental Wellness Plan (DWP) and the Dental Wellness Plan Kids. The core goal is to align DWP/DWP Kids reimbursement with Hawki (Healthy and Well Kids in Iowa) reimbursement rates to maximize provider participation and member access.

Key Provisions

  • Reimbursement method: A participating provider shall be reimbursed for services at the higher of:
    • The percentage of the usual, customary, and reasonable (UCR) fee, or
    • The percentage of the commercial dental insurance billed charges.
  • Alignment with Hawki: The higher-reimbursement approach is intended to align DWP and DWP Kids reimbursement rates with those under the Hawki program (pursuant to chapter 514I).
  • Objective: By aligning rates with Hawki, the bill aims to maximize dental provider participation in the plans and enhance member access.

Who Is Affected

  • Dental providers participating in the Dental Wellness Plan and the Dental Wellness Plan Kids.
  • Enrollees/members of the DWP and DWP Kids, whose access and reimbursement realism are intended to improve as a result of broader provider participation.
  • The Hawki program (as the benchmark for alignment).

Procedural and Timeline Aspects

  • Introduced: February 17, 2025.
  • Referral: Referred to Health and Human Services.
  • Subcommittee action: As of February 20, 2025, the bill is under subcommittee review (Klimesh, Costello, and Trone Garriott).
  • Sponsors: Petersen, Zimmer, Trone Garriott, and Donahue (all listed as primary sponsors).

Potential Impacts and Considerations

  • Access and Participation: By offering reimbursement at least as favorable as the higher of UCR-derived percentages or commercial charges, and aligning with Hawki, more providers may participate in DWP and DWP Kids, potentially increasing patient access.
  • Cost Implications: The higher-reimbursement framework could raise plan expenditures if a significant share of billed charges exceed UCR, depending on actual provider charges and plan utilization.
  • Implementation: Details on rate setting, auditing, and implementation timelines are not provided in the excerpt; final language would clarify administrative processes.

Bottom Line

S.F. 327 focuses on harmonizing reimbursement for DWP and DWP Kids with Hawki by ensuring providers are paid at the higher of UCR-based or commercial-charge-based percentages. The bill targets improved provider participation and patient access, and is currently advancing through the Health and Human Services committee structure in the Iowa General Assembly.

Compiled from official sources — confirm details with the bill’s official record.

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