WVDA 114th Annual Session - July 24 & 25, 2020 - The Greenbrier

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New law requires health insurance companies to accept assignment of benefits

After lobbying legislators beginning the first day of the 2020 session, the West Virginia Dental Association succeeded in having House Bill 4061 passed the last night of the session – 60 days later with only two hours remaining before the close of the session – allowing patients to have their dental insurance benefits paid directly to their dentist.   

Known as “assignment of benefits,” the law requires dental insurance plans to honor an assignment, made in writing by the person covered under the policy, of payments due under the insurance policy to a dentist or a dental corporation for services provided to the covered person that are covered under the policy.

The policy includes the following provisions of the West Virginia Insurance Code, designated:
Chapter 33, Article 15-22; Chapter 33, Article 16-18; Chapter 33, Article 24-45; Chapter 33, Article 25-22; and Chapter 33, Article 25A-36.

(a) Any entity regulated under this article that provides dental care coverage to a coveredperson shall honor an assignment, made in writing by the person covered under the policy, of payments due under the policy to a dentist or a dental corporation for services provided to the covered person that are covered under the policy.  Upon notice of the assignment, the entity shall make payments directly to the provider of the covered services.  A dentist or dental corporation with a valid assignment may bill the entity and notify the entity of the assignment. Upon request of the entity, the dentist or dental corporation shall provide a copy of the assignment to the entity.

(b) A covered person may revoke an assignment made pursuant to subsection (a) of this sectionwith or without the consent of the provider.  The revocation shall be in writing.  The covered person shall provide notice of the revocation to the entity.  The entity shall send a copy of the revocation notice to the dentist or dental corporation subject to the assignment.  The revocation is effective when the entity and the provider have received a copy of the revocation notice.  The revocation is only effective for any charges incurred after both parties have received the revocation notice.
(c) If, under an assignment authorized in subjection (a) of this section, a dentist or dentalcorporation collects payment from a covered person and subsequently receives payment from the entity, the dentist or dental corporation shall reimburse the covered person, less any applicable copayments, deductibles, or coinsurance amounts, within 45 days.

(d) Nothing in this section limits an entity to determine the scope of the entity’s benefits,services, or any other terms of the entity’s policies or to negotiate any contract with a licensed health care provider regarding reimbursement rates or any other lawful provisions.

                 
Laws regulating dental insurance have had a direct impact on patients who purchase coverage, which is about half of the population.  Most insurers allow covered patients to see their choice of dentist, with the caveat that certain features may be reduced for seeing a dentist that is not in the insurer’s network. When a patient who’s seeing an out-of-network dentist wants insurance payment for their covered service to go directly to their dentist – known as “assignment of benefits” – many insurance companies refuse to comply with the patient’s request.  

The burden of navigating payment for covered services lands squarely on the patient who simply chose to see the “dentist of their choice.”  About half the states have a law that requires insurers to follow the patient’s directive to pay the dentist directly for covered services. The end result is a law that allows patients to choose how the dental coverage product they’ve purchased is utilized.  

Passage of House Bill 4061 by the Legislature and signed into law by Governor Jim Justice, assures patients can chose the dentist of their choice without financial penalties commonly imposed by third party payers.  The new law becomes effective June 5, 2020.

       

Governor approves lawmakers expanding Medicaid to include adult dental coverage

Responding to requests from the West Virginia Dental Association, lawmakers of the House and Senate passed Senate Bil 648 during the 2020 session expanding the Medicaid program to provide dental coverage for adult Medicaid recipients.  The law provides selected coverage for adults 21 and over.  
Effective June 5, 2020, the new law calls for the West Virginia Department of Health and Human Resources to seek authority from the Centers for Medicare and Medicaid Services to implement the program.  
 
Published below are provisions of Senate Bill 648, sought by the Association and signed into law by Governor Jim Justice.  

Medicaid Program: Dental Care.

“Cosmetic services” means dental work that improves the appearance of the teeth, gums, or bite, including, but not limited to, inlays or onlays, composite bonding, dental veneers, teeth whitening, or braces.

“Diagnostic and preventative services” means dental work that maintains good oral health and includes oral evaluations, routine cleanings, x-rays, fluoride treatment, filings, and extractions.

“Restorative services” means dental work that involves tooth replacement, including, but not limited to, dentures, dental implants, bridges, crowns, or corrective procedures such as root canals.

The Department of Health and Human Resources shall extend Medicaid coverage to adults age 21 and over covered by the Medicaid program for diagnostic and preventative dental services and restorative dental services, excluding cosmetic services.  This coverage is limited to $1,000 each budget year.  Recipients must pay for services over the $1,000 yearly limit, or to be in compliance with new federal legislation that further expands eligibility for dental care for adult recipients.

The Department of Health and Human Resources is responsible for the implementation of, and program design for, a dental care system to reduce the continuing harm and continuing impact on the health care system in West Virginia.  The dental health system design shall include oversight, quality assurance measures, case management, and patient outreach activities.  The Department of Health and Human Resources shall assume responsibility for claims processing in accordance with established fee schedules and financial aspects of the program necessary to receive available federal dollars and to meet federal rules and regulations.  The Department of Health and Human Resources shall seek authority from the Centers for Medicare and Medicaid Services to implement the provisions of this article.

The provisions of this section enacted during the 2020 regular legislative session shall only become effective upon approval from the federal Centers for Medicare and Medicaid Services of the provider tax as set forth in 11-27-10a of this code.


(Provider tax referred to in 11-27-10a above is a tax on managed care organizations and HMOs.) 

 

Dr. Douglas Robertson installed President

During services conducted at the 2020 Semiannual Session, January 18, at the Marriott in Charleston, Dr. Douglas Robertson was installed President by Dr. Brett Eckley, outgoing President.  Other officers installed were Dr. Eleisha Nickoles, President Elect; Dr. Daniel T. Carrier, Vice President; Dr. Lance Pittman, Secretary; Dr. Gerard Veltri, Treasurer; Dr. Mike Richardson and Dr. Kerri Simpson, ADA Delegates.

The West Virginia Dental Association invites dentists, dental hygienists, dental assistants, dental suppliers and dental laboratories to its Semiannual Session in January and Annual Session in July of each year.  A host of scientific and clinical programs are presented at each meeting, assuring attendees of worthwhile educational experiences. 

For information call 304-344-5246, or email richard@wvdental.org or susan@wvdental.org   For the latest news go to: www.wvdental.org

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