{ legislative & regulatory } by Olivia Wilson • MDA Legislative Liaison


Missouri’s New Dental Insurance Laws: What You Need to Know


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ach year on August 28, laws passed during the regular Missouri legisla- tive session that did not include an emergency clause go into effect. Among these new laws are several legislative priorities proposed and successfully passed by your MDA lobby team.


PRE-PAID DENTAL PLANS NOW REQUIRED TO ABIDE BY AOB, PROMPT CREDENTIALING LAWS


In Missouri, “pre-paid dental plans” such as Delta Dental of Missouri are not legally considered insurance carriers, therefore, they do not fall under the jurisdiction of the Department of Insurance and are not bound by state insurance regulations. During the 2022 Missouri legislative session, the MDA lobbying team successfully added “pre-paid dental plans” to two important insurance statutes: Assignment of Benefits and Prompt Credentialing.


ASSIGNMENT OF BENEFITS


Assignment of Benefits (AOB) refers to a payment arrangement between a patient and their insurance company, in which a patient requests their insurance provider pay their health benefit directly to their provid- er. Without AOB laws, an insurance com- pany may transfer a health benefit directly to the patient, therefore forcing the provider to track down the patient to collect payment. As of August 28, 2022, pre-paid dental plans (such as Delta Dental of Missouri) are legally required to abide by Missouri’s AOB laws. Up until this point, pre-paid dental plans were not required to abide by AOB laws.


EXCEPTIONS: Despite this update to Missouri’s AOB statute, if a patient’s plan is federal or self-funded it falls under ERISA/ federal laws, therefore the Missouri AOB statute does not apply. Always be sure to


16 focus | SEP/OCT 2022 | ISSUE 5


check the patient’s insurance and collect pay- ment prior to rendering services.


If you continue to have issues with pre-paid dental plans abiding by the new AOB law, reference RSMo 376.427 in your communica- tions with the carrier.


PROMPT CREDENTIALING


In 2020, the Missouri General Assembly passed a series of changes to the state’s prompt credentialing law (RSMo 376.1578).


Within two working days of receiving a credentialing application, the insurance com- pany must send a notice of receipt to the pro- vider. If the insurance company determines information is missing from the application, they have 10 days from the day the notice of receipt was sent to request any additional information from the provider. Within two working days of receiving the additional information, the health insurer must send a notice to the provider informing him/her they have submitted a complete application.


Within 60 days of receiving the completed application, the insurance carrier must make a decision as to approve or deny the provid- er’s application (certain exceptions apply). If the credentialing application is approved, the insurance carrier must provide payments for those covered health services performed by the provider during the credentialing period.


As of August 28, pre-paid dental plans such as Delta Dental of Missouri also are required to abide by the state’s prompt credentialing laws.


If you continue to face difficulties getting credentialing with pre-paid dental plans in particular, reference RSMo 376.1575 in your communications with the insurance carrier. This section of the credentialing law defines


“health carrier” to include pre-paid dental plans licensed under RSMo 354.700.


IN-OFFICE DENTAL PLANS NOW LEGAL


For many years, dental providers across the state have offered “in-office” plans to their patients who may not have dental insurance or prefer not to use their dental insurance benefits. During the 2022 legislative session, the MDA lobbying team successfully passed legislation to make crystal-clear in law that dental providers may legally, officially offer these plans to their patients.


In-office dental plans, also referred to as “medical retainer agreements” in statute, previously was permitted only for physicians. Now, dental providers have the green light to offer these plans to their patients. See RSMo 376.1800 for more information.


To look up any statute referred to in this article (RSMo) go to revisor.mo.gov. For more information about our 2022 legisla- tive wins, please visit the MDA Legislative History and Time Line at modental.org/ legislativetimeline.


I want to thank you, our members, for mak- ing these victories possible. Our legisla- tive successes would not happen without your continued advocacy and support of MODentPAC. Our team already is prepar- ing for the next legislative session, and we look forward to continuing to advocate for you. Please also save the dates and plan to join us: February 1, Virtual Town Hall and March 1, Dental Day at the Capitol. Please do not hesitate to reach out to me with any questions.


Olivia Wilson is the MDA Legislative Liaison and Lobbyist. Contact her at olivia@molobby.com.


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