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Bill

SB 6307

Enhancing transparency in dental benefits to ensure full patient benefits.

2023-2024 Regular Session Introduced by Phil Fortunato

Bans certain dental contract restrictions and guarantees parity in payments to noncontracting dentists, ensuring patients receive full benefits and clearer access.

First reading, referred to Health & Long Term Care.
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Bill Summary · SB 6307

Summary of Senate Bill 6307 (S-4405) — Enhancing Transparency in Dental Benefits to Ensure Full Patient Benefits

Overview

  • Bill: SB 6307 (S-4405)
  • Title: Enhancing transparency in dental benefits to ensure full patient benefits
  • Jurisdiction: State of Washington, 68th Legislature, 2024 Regular Session
  • Introduced: January 29, 2024
  • Status: First reading; referred to Health & Long Term Care
  • Primary sponsor: Senator Fortunato
  • Purpose: To improve transparency and ensure patients receive the full benefits of their dental coverage by restricting certain contracting practices between health care service contractors and dentists, and by guaranteeing parity in payments to noncontracting dentists.

What the bill does (Key Provisions)

  1. Prohibit certain contracting practices (dental services)

    • Health care service contractors and any contract or participating provider agreement with a dentist may not:
      • (a) Require a participating dentist to provide services to an enrolled patient at fees set by or subject to approval of the contractor unless the services are “covered services” (including services that would be reimbursable but for contractual limitations such as benefit maximums, deductibles, coinsurance, waiting periods, or frequency limitations under the applicable contract).
      • (b) Prohibit a participating dentist from offering or providing to an enrolled patient dental services that are not covered services on terms acceptable to the dentist and the patient.

  2. Noncontracting provider reimbursement parity

    • An employee benefit plan or health insurance policy must pay or reimburse a noncontracting provider dentist the same as a contracting provider dentist.

  3. Definition of “covered services”

    • “Covered services” are dental services that are reimbursable under the applicable subscriber agreement or would be reimbursable but for the application of contractual limitations (e.g., benefit maximums, deductibles, coinsurance, waiting periods, or frequency limitations).

  4. Statutory amendments

    • The bill would amend RCW 48.44.495 and related provisions (2010 c 228 s 3) to implement these requirements.

Who is affected

  • Patients/Enrollees: Likely benefit from clearer access to full benefits and potential reductions in disparities between contracting and noncontracting providers.
  • Dentists (Participating and Nonparticipating): Subject to new constraints on fee-setting tied to covered services and to parity payment rules for noncontracting dentists.
  • Health Care Service Contractors & Dental Networks: Must adjust contracts and reimbursement practices to comply with parity and coverage definitions.
  • Employer-Based Plans & Health Insurance Policies: Must implement parity between contracting and noncontracting dentists.

Procedural and timeline aspects

  • Status: First reading, committee referral to Health & Long Term Care.
  • Next steps: Committee hearings and potential amendments, followed by floor consideration. If enacted, provisions would become effective according to the bill’s final statutory language (specific effective dates not listed in the provided text).

Potential impact and considerations

  • Aims to reduce patient cost-shares and confusion by ensuring that noncovered services are not inappropriately restricted and that noncontracting dentists are paid in parity with contracting ones.
  • Could require significant administrative changes for insurers and networks to align fee structures and reimbursement rules.
  • May influence dentist participation decisions and the availability of noncovered services within dental benefit plans.

If you’d like, I can tailor this summary to emphasize perspectives for patients, providers, or insurers, or compare these provisions to current Washington statute.

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

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