Iowa SF 470: A bill for an act relating to the medical use of cannabidiol including the scheduling of a cannabidiol investigational product approved as a prescription drug medication under federal law and including effective date provisions. (Formerly SF 282.)

Bill Text

Senate
File
470
-
Enrolled

Senate
File
470

AN
ACT

RELATING
TO
PRIOR
AUTHORIZATION
FOR
DENTAL
CARE
SERVICES,

NOTICE
TO
DENTAL
CARE
PROVIDERS
THAT
A
DENTAL
CARE
SERVICE

PLAN
IS
STATE-REGULATED,
AND
THE
RECOVERY
OF
OVERPAYMENTS
BY

A
DENTAL
CARRIER.

BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:

Section
1.
NEW
SECTION

.
514C.3D
Prior
authorization
for

dental
care
services.

1.
Definitions.
As
used
in
this
section
unless
the
context

otherwise
provides:

a.
“Commissioner”
means
the
commissioner
of
insurance.

b.
“Covered
person”
means
the
same
as
defined
in
section

514C.3C.

c.
“Dental
care
provider”
means
the
same
as
defined
in

section
514C.3C.

d.
“Dental
care
service
plan”
means
the
same
as
defined
in

section
514C.3C.

e.
“Dental
care
services”
means
the
same
as
defined
in

section
514C.3C.

f.
“Dental
carrier”
means
the
same
as
defined
in
section

514C.3C.

g.
“Prior
authorization”
means
a
determination
by
a
dental

carrier
in
response
to
a
request
submitted
by
a
dental
care

provider
as
to
whether
a
specific
dental
care
service
proposed

by
the
dental
care
provider
for
a
covered
person
will
be

Senate
File
470,
p.
2

reimbursed
at
a
specified
amount,
subject
to
any
applicable

coinsurance
or
deductible
required
under
the
covered
person’s

dental
care
service
plan.

2.
Prior
authorization.

a.
A
dental
carrier
shall
not
deny
a
claim
submitted
by
a

dental
care
provider
for
dental
care
services
approved
by
prior

authorization.

b.
A
dental
carrier
shall
reimburse
a
dental
care
provider

at
the
contracted
reimbursement
rate
for
a
dental
care
service

provided
by
the
dental
care
provider
to
a
covered
person
per

a
prior
authorization.

3.
Exceptions.
Subsection
2
shall
not
apply
if
any
of
the

following
apply
for
each
dental
care
service
for
which
a
dental

care
provider
is
denied
reimbursement:

a.
On
the
date
that
the
dental
care
service
was
provided

by
the
dental
care
provider
to
the
covered
person
per
a

prior
authorization,
a
benefit
limitation
including
but
not

limited
to
an
annual
maximum
or
a
frequency
limitation
that

was
not
applicable
at
the
time
of
the
prior
authorization
had

been
reached
due
to
utilization
of
the
dental
care
service

plan
subsequent
to
the
dental
carrier
issuing
the
prior

authorization.

b.
The
dental
care
provider
submits
a
claim
for
dental
care

services
approved
by
prior
authorization
and
the
documentation

of
dental
care
services
fails
to
support
the
claim
for

dental
care
services
as
originally
authorized
by
the
prior

authorization.

c.
Subsequent
to
the
issuance
of
a
prior
authorization,
and

prior
to
the
provision
of
dental
care
services
authorized
by

the
prior
authorization,
a
covered
person
receives
additional

dental
care
services,
or
a
change
in
the
dental
condition
of

the
covered
person
occurs,
such
that
the
dental
care
services

authorized
by
the
prior
authorization
are
no
longer
considered

medically
necessary
based
on
the
prevailing
standard
of
care.

d.
Subsequent
to
the
issuance
of
a
prior
authorization,
and

prior
to
the
provision
of
dental
care
services
authorized
by

the
prior
authorization,
a
covered
person
receives
additional

dental
care
services,
or
a
change
in
the
dental
condition

Senate
File
470,
p.
3

of
the
covered
person
occurs,
such
that
on
the
date
that

the
dental
care
service
is
to
be
provided
a
request
for

prior
authorization
of
the
dental
care
service
would
require

disapproval
pursuant
to
the
terms
and
conditions
for
coverage

under
the
covered
person’s
current
dental
care
service
plan.

e.
A
payor
other
than
the
dental
carrier
is
responsible
for

payment
for
the
dental
care
service.

f.
A
dental
care
provider
has
already
received
payment
from

the
dental
carrier
for
the
dental
care
services
identified
in

the
claim
for
reimbursement.

g.
The
claim
was
submitted
fraudulently
to
the
dental

carrier.

h.
The
dental
care
provider,
covered
person,
or
other

person
not
related
to
the
dental
carrier
provided
inaccurate

information
that
the
dental
carrier
relied
on,
in
whole

or
in
part,
for
the
dental
carrier’s
prior
authorization

determination.

i.
On
the
date
that
the
dental
care
service
was
provided
by

the
dental
care
provider
to
the
covered
person
per
the
prior

authorization,
the
covered
person
was
ineligible
to
receive
the

dental
care
service
and
the
dental
carrier
did
not
know,
and

with
the
exercise
of
reasonable
care
could
not
have
known,
of

the
covered
person’s
ineligibility.

j.
Prior
to
providing
a
dental
care
service
approved
by

prior
authorization,
the
dental
care
provider
terminated

participation
in
the
dental
carrier’s
network
under
which
the

dental
carrier
issued
the
prior
authorization
for
such
dental

care
service.

4.
Waiver
prohibited.
The
requirements
of
this
section

shall
not
be
waived
by
contract.
Any
contractual
arrangement

contrary
to
this
section
shall
be
null
and
void.

5.
Rules.
The
commissioner
may
adopt
rules
pursuant
to

chapter
17A
to
administer
this
section.

Sec.
2.
NEW
SE