HB3323 101ST GENERAL ASSEMBLY

LRB101 08700 RAB 53785 b

101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB3323

Introduced , by Rep. Kambium Buckner

SYNOPSIS AS INTRODUCED:

New Act

Creates the Uniform Dental Electronic Transactions Act. Provides that the Act applies to all dental plan carriers. Requires all dental plan carriers and dental care providers to exchange claims and eligibility information electronically using the transactions, companion guides, implementation guides, and timelines required under the Act in order to be compensable by the dental plan carrier. Provides that no dental plan carrier or provider may add to or modify the uniform companion guides. Grants the Director of Insurance the right to investigate complaints filed under the Act. Provides the required specifications of any complaint filed. Provides that the Director may impose a civil monetary penalty if the Director determines that there has been a violation of the Act. Requires the Department of Insurance to adopt rules. Defines terms. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Uniform Dental Electronic Transactions Act.

Section 5. Purpose. The purpose of this Act is to standardize the forms used in the billing and reimbursement of dental care, reduce the number of forms used, increase efficiency in the reimbursement of dental care through standardization, and encourage the use of and prescribe a timetable for implementation of electronic data interchange of dental care expenses and reimbursement.

Section 10. Applicability. Except as may be otherwise specifically provided, this Act applies to all dental plan carriers.

Section 15. Definitions. As used in this Act:

"Dental care provider" means either a general dentist or a dentist who is a licensed specialist.

"Dental plan carrier" means an entity subject to the insurance laws and regulations of this State or subject to the jurisdiction of the Director that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of dental care services, including an accident and health insurance company, a health maintenance organization, or any other entity providing a plan of dental insurance, dental benefits, or dental health care services.

"Dental plan carrier" includes limited health service organizations, dental service plans, and voluntary health service plans.

"Dental plan carrier" does not include employee or employer self-insured dental benefit plans under the federal Employee Retirement Income Security Act of 1974.

"Dentist" means a person licensed to practice dentistry in any state.

"Department" means the Department of Insurance.

"Director" means the Director of Insurance.

Section 20. Uniform electronic claims and eligibility transactions required.

(a) Beginning January 1, 2020, no dental plan carrier is required to accept from a dental care provider eligibility for a dental plan transaction or dental care claims or equivalent encounter information transaction except as provided in this Act.

(b) Beginning January 1, 2020, all dental plan carriers shall accept from dental care providers eligibility for a dental plan transaction described under the Code of Federal Regulations, title 45, part 162, subpart L and the dental care claims or equivalent encounter information transaction described under the Code of Federal Regulations, title 45, part 162, subpart K.

(c) Beginning January 1, 2020, all dental plan carriers shall transmit to dental care providers the eligibility for a dental plan as set forth in the Code of Federal Regulations, title 45, part 162, subpart L and the dental care payment and remittance advice transaction set forth in the Code of Federal Regulations, title 45, part 162, subpart P.

(d) All dental plan carriers and dental care providers must exchange claims and eligibility information electronically using the transactions, companion guides, implementation guides, and timelines required under this Act in order to be compensable by the dental plan carrier.

(e) Each of the transactions described in subsection (a) through (d) shall require the use of a single, uniform companion guide to the implementation guides described in the Code of Federal Regulations, title 45, part 162.

Section 25. Establishing uniform, standard companion guides.

(a) The Department shall adopt rules as necessary to implement this Act, including the use of the uniform, standard companion guides required under subsection (e) of Section 20.

(b) A dental plan carrier or dental care provider may not add to or modify the uniform companion guides.

(c) In adopting the rules under this Section, the Department shall not require data content that is not essential to accomplish the purpose of the transactions in Section 20.

Section 30. Compliance and investigations. The Director has the right to investigate complaints filed under this Act.

Complaints filed under this Section must:

(1) be filed in writing, either on paper or electronically;

(2) name the person that is the subject of the complaint and describe the acts or omissions believed to be in violation of this Act; and

(3) be filed within 180 days after the complainant knew or should have known that the act or omission complained of occurred.

The Director may prescribe additional procedures for the filing of complaints as required to satisfy the requirements of this Section.

The Director may impose a civil monetary penalty if the Director determines that there has been a violation of this Act.

Section 99. Effective date. This Act takes effect upon becoming law.