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

Summary

The Senate Commerce Committee of the State of New Jersey, in a statement dated June 9, 2022, reports favorably and with committee amendments Senate Bill No. 765. As amended, a carrier may not stop a participating dentist from billing a covered person for a covered service if the dentist gives advance notice that the carrier may not pay, explains alternatives in writing, obtains written consent and accepts the plan amount as payment in full. Carriers may not maintain dental plans that use down-coding to block collection of the fee for the actual service, or bundling that labels a procedure nonbillable to the patient except as the statement describes. The amendments clarify terminology and when bundling can be used.

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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.

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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