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Bill

HD 335

An Act to create direct dental care agreements

194th Legislature (2025-2026) Introduced by Homar Gomez

Creates a direct dental care framework: dentists and patients sign periodic-fee agreements for defined services, outside insurance and not subject to insurance regulation.

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Bill Summary · HD 335

Summary: An Act to Create Direct Dental Care Agreements (House Bill HD 335)

Overview

This proposed Massachusetts bill would authorize a new framework for direct dental care arrangements outside traditional fee-for-service insurance models. It creates a statutory pathway for dentists and patients to enter direct dental care agreements based on periodic fees for defined services, rather than payments through dental insurance reimbursements. The measure inserts a new Section 53A into Chapter 112 and clarifies that such agreements are not insurance products and fall outside certain insurance regulatory oversight.

Key Provisions

  • New section inserted: Chapter 112, after Section 53, creating Section 53A to govern direct dental care.
  • Definitions (Section 53A(a)):
    • “Dentist” = a licensed dental practitioner.
    • “Direct dental care” = screening, assessment, and diagnosis of oral health and disease.
    • “Direct dental care agreements” = agreements for delivering direct dental care between a dentist and a patient, based on a periodic fee for specified services over a defined period, rather than fee-for-service under insurance.
    • “Patient” = an individual entering into the direct care arrangement.
  • Authorization (Section 53A(b)):
    • Dentists and patients may enter into direct dental care agreements.
    • Agreements must specify: (i) the services provided in exchange for the periodic payment; (ii) the periodic fee and any additional fees; (iii) that termination of the agreement does not affect other agreements entered under this section; and (iv) that the dentist cannot submit fee-for-service claims for services covered by the agreement.
  • Regulatory status (Section 53A(c)):
    • A dentist entering into a direct dental care agreement is not considered an insurance company.
    • Such agreements are not subject to oversight by the Massachusetts Division of Insurance or to subsection 5 of Section 52A.
    • The agreements are not insurance products or plans.

How Direct Dental Care Works (Summary)

  • A licensed dentist and a patient may establish a direct care agreement.
  • The patient pays a periodic fee for predefined services over a set period.
  • The agreement lays out what services are covered, the exact fees (and any extras), and how termination affects other agreements.
  • The dentist may not bill insurance for services covered under the direct care agreement.

Regulatory and Oversight Implications

  • These arrangements are explicitly exempt from traditional insurance oversight.
  • They are not classified as insurance products/plans.
  • This creates a distinct regulatory category separate from standard health/dental insurance.

Parties Affected

  • Dentists licensed in Massachusetts.
  • Patients seeking alternative, predictable-cost dental care arrangements outside insurance-based models.

Procedural and Timeline Notes

  • The bill text indicates introduction and filing in the 2025-2026 General Court session (with historical reference to a similar measure in 2023-2024).
  • The provided text does not specify an effective date or implementation timeline beyond establishment of the new statutory section.

Potential Impacts and Considerations

  • Pros: Improved cost predictability for patients; potential for expanded access to dental services via direct care models; greater flexibility for dentists to set periodic fees.
  • Cons/Concerns: Reduced regulatory oversight could raise consumer protection questions; implications for traditional insurance coverage and coordination of benefits; need for clear disclosure on services, fees, and termination rights.

Context

  • The measure is identified as a proposed bill and references a similar matter previously filed as House No. 965 in the 2023-2024 session.
  • If enacted, this would create a distinct pathway for direct dental care arrangements within Massachusetts law.

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

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