ON FEBRUARY 26, 2024, THE SENATE ADOPTED AMENDMENT #1 AND PASSED SENATE BILL 677, AS AMENDED.
AMENDMENT #1 rewrites the bill to expand on dental benefit plans, methods of payment, and related terms as follows:
(1) This amendment prohibits a dental benefit plan from containing restrictions on methods of payment from the dental benefit plan or its vendors to the dentist in which the only acceptable payment method is a credit card payment;
(2) When initiating or changing payments to a dentist using electronic funds transfer payments, including virtual credit card payments, this amendment requires a dental benefit plan or its vendors to (i) notify the dentist if any fees are associated with a particular payment method; (ii) advise the dentist of the available methods of payment; and (iii) provide clear instructions to the dentist as to how to select an alternative payment method;
(3) This amendment prohibits a dental benefit plan or its vendor, that initiates or changes payments to a dentist for healthcare electronic fund transfer and remittance advice transactions under federal regulations, from charging a fee solely to transmit the payment to the dentist unless the dentist has consented to the fee;
(4) When transmitting healthcare electronic fund transfer and remittance advice transactions under federal regulations, this amendment authorizes a dentist agent to charge reasonable fees for payments related to transaction management, data management, portal services, and other value-added services in addition to the bank transmittal;
(5) This amendment requires a dental carrier that contracts or renews a contract with a provider to (i) make the dental carrier's current dental benefit plan policies or guidelines available online; and (ii) if requested by a provider, send a copy of the policies to the provider through mail or electronic mail;
(6) This amendment requires a dental benefit plan to furnish to providers (i) a summary of all material changes made to a dental benefit plan no less than 30 days prior to the date the material change takes effect; (ii) the adjustment of a claim submitted to a dental benefit plan to a less complex or lower cost procedure code ("downcoding") and the practice of combining distinct dental procedures into one procedure for billing purposes ("bundling") policies that the dental carrier reasonably expects to be applied to the provider's services as a matter of policy; and (iii) a description of the dental benefit plan's utilization review procedures, including a procedure for a covered person to obtain a review of an adverse determination and a statement of a provider's rights and responsibilities regarding the procedure;
(7) This amendment prohibits a dental carrier from offering or maintaining in this state a dental benefit plan that does the following: (i) based on the provider's contracted fee for covered services, uses downcoding in a manner that prevents a provider from collecting the fee for actual services performed either from the dental benefit plan or the patient; or (ii) uses bundling in a manner where a procedure code is labeled as nonbillable to the patient unless, under generally accepted practice standards, the procedure code is for a procedure that may be provided in conjunction with another procedure;
(8) This amendment requires a dental carrier to ensure that an explanation of benefits for a dental benefit plan includes the reason for any downcoding or bundling result;
(9) This amendment establishes that a violation of this amendment may subject the insurer, dental carrier, dental service plan, third-party administrator, or other party that covers any dental services to sanctions;
(10) This amendment does not apply to the TennCare program or a successor program provided for in the Medical Assistance Act of 1968, the CoverKids Act of 2006, or a successor program; and
(11) For purposes of this amendment, "dentist agent" means a person who establishes an agency relationship contract with a dentist to process bills for services provided by the dentist under terms and conditions established between the agent and dentist. Such contracts may permit the dentist agent to submit bills, request reconsideration, and receive reimbursement.

Statutes affected:
Introduced: 56-30-108(b), 56-30-108
Amended with SA0550 -- 02/26/2024: 56-30-108(b), 56-30-108, 56-7-1017