Senate Commerce Committee Statement to Senate, No. 765 (State of New Jersey, June 9, 2022)

Summary

This is a Senate Commerce Committee statement to the New Jersey Senate on Senate Bill No. 765, with committee amendments, dated June 9, 2022. The committee reports the bill favorably. As amended, the bill prohibits a carrier from precluding a participating dentist from billing a covered person for a covered service under a dental plan if the dentist gives advance notice, a written explanation of alternatives, and obtains written consent. The dentist must accept as payment in full the amount the carrier would have paid. The bill also bars dental plans from using down-coding or bundling in ways that prevent the dentist from collecting the fee for the actual service performed. The committee amendment clarifies the bill's scope and when a carrier can bundle covered services.

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     SENATE COMMERCE COMMITTEE

                     STATEMENT TO

                   SENATE, No. 765
                    with committee amendments



 STATE OF NEW JERSEY
                        DATED: JUNE 9, 2022

    The Senate Commerce Committee reports favorably and with
committee amendments Senate Bill No. 765.
    As amended, this bill prohibits a carrier from precluding a
participating dentist from billing a covered person for a covered
service under a dental plan and collecting payment from the covered
person for the covered service if the participating dentist:
    (1) notifies the covered person prior to performing the covered
service that the dentist may not be paid by the carrier and that the
covered person is responsible for payment of the covered service;
    (2) provides the covered person an explanation, in writing, of the
benefits and material cost differences of suitable alternative options for
the service, and that the alternative selected may not be covered by the
plan, in advance of it being performed;
    (3) obtains the covered person’s consent, in writing, to the
performance of the service and the participating dentist makes the
written consent available to the carrier upon request; and
    (4) accepts as payment in full the amount the participating dentist
would have accepted from the carrier under the covered person’s
dental plan, including bundled payments.
    Under the bill, a carrier is prohibited from maintaining a dental
plan that:
    (1) based on the participating dentist’s contracted fee for covered
services, uses down-coding in a manner that prevents a dental provider
from collecting the fee for the actual service performed from either the
dental plan or the patient; or
    (2) uses bundling of covered services in a manner where a
procedure is labeled as nonbillable to the patient unless, consistent
with generally accepted practice standards, the procedure may be
provided in conjunction with another procedure.
    The provisions of the bill do not apply in cases where the service
performed by the participating dentist is required as a result of a prior
service by the dentist that was inconsistent with generally accepted
practice standards as determined by a licensed dentist.
    This bill was pre-filed for introduction in the 2022-2023 session
pending technical review. As reported, the bill includes the changes
required by technical review, which has been performed.
                              2

COMMITTEE AMENDMENTS
    The committee amended the bill to clarify the terminology
regarding the scope of the bill and when a carrier can employ the
bundling of covered services.


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