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HB 2247

Prohibiting certain terms in a contract between a health insurer and a dentist and requiring that reviews, audits or investigations of healthcare providers be completed within six months.

2025-2026 Regular Session

HB 2247 caps dental audits at 6 months, protects prior-authorized procedures, bans insurer-dentist fee caps for non-covered services, and shifts about $3.3M/yr to plan members.

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Bill Summary · HB 2247

HB 2247 — Summary (Kansas, 2025)

Purpose

HB 2247 seeks to (1) limit how long insurers and nonprofit dental service corporations may audit or recover previously paid dental claims, (2) protect dentists and patients where a procedure was approved by prior authorization, and (3) prohibit certain contract terms between health insurers and participating dentists that restrict billing for non‑covered services.

Key provisions

  • Time limit on audits/recoupments

    • Any review, audit, or investigation by a nonprofit dental service corporation that results in recoupment or setoff of funds must be completed within 6 months after the claim was originally paid.
    • Exceptions (no six‑month limit): fraud; claims that a provider knew or should have known were a pattern of inappropriate billing; coordination‑of‑benefits issues; claims governed by federal law/regulation that allow longer review periods.

  • Prior authorization and claim denials

    • Defines “prior authorization” as a written insurer/URE communication that a specific procedure is covered and reimbursable at a specified amount (subject to coinsurance/deductibles) in a prescribed format.
    • A dental benefit plan or utilization review entity (URE) cannot deny a claim for procedures specifically included in a prior authorization, except where:
    • Benefit limits (e.g., annual maximums or frequency limits) that were not in effect at authorization are exceeded by subsequent utilization;
    • Submitted documentation clearly fails to support the authorized claim;
    • New procedures or changed patient condition after authorization render the previously authorized procedure no longer medically necessary under prevailing standard of care;
    • New procedures or condition changes mean the authorized procedure would now require disapproval.

  • Prohibited contractual terms between insurer and dentist (amendment to K.S.A. 40‑2,185)

    • Contracts cannot require dentists to provide services at insurer‑set fees unless the service is a covered service.
    • Contracts cannot (a) limit fees a dentist may charge for non‑covered services, or (b) both disallow payment for a service that would ordinarily be covered and simultaneously prohibit the dentist from billing the patient when there is dental necessity.
    • “Dental necessity” is defined by a prudent dentist standard consistent with generally accepted dental practice and applicable ADA/AAPD guidance.

  • Repeal

    • The bill repeals the existing version of K.S.A. 40‑2,185 and replaces it with the amended provisions.

Who is affected

  • Participating dentists and dental providers
  • Dental benefit plans, nonprofit dental service corporations, and utilization review entities
  • Patients covered by dental plans (insureds), including State Employee Health Plan members (impacts primarily out‑of‑pocket costs)
  • Kansas Department of Insurance and Kansas Dental Board (administrative oversight)

Fiscal impact (per Fiscal Note, Feb 20, 2025)

  • Department of Administration (State Employee Health Benefits): no direct fiscal effect to the agency.
  • Using 2024 claims, enactment would shift approximately $3,332,411 in annual costs to plan members (higher out‑of‑pocket for dental services) without increasing dental benefits.
  • Department of Insurance and Dental Board: indicate no fiscal effect.

Procedural status / timeline

  • Introduced (filed) Jan 30, 2025; referred to Committee on Insurance.
  • Readings and committee actions recorded through March–May 2025 (see legislative history for detailed timeline).
  • Effective date: upon publication (bill text states it takes effect after publication in statute book).

Notes

  • The bill targets provider protections and billing transparency rather than expanding covered dental benefits.
  • The six‑month audit limit excludes serious situations (fraud, coordinated benefits, specialty standards, federal rules) to allow longer review where warranted.

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

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