News and Updates

HB 2558 Dental Capitation Payments: Comments and Background

By: OliversonH.B. No. 2558

A BILL TO BE ENTITLED

AN ACT

relating to capitation payments under a contract with a health

maintenance organization for the provision of dental care services.

       BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

       SECTION 1.  Section 843.3115, Insurance Code, is amended by

adding Subsection (c) to read as follows:

       (c)  If a contract between a health maintenance organization

and a dentist or an entity that provides dental care services uses

capitation as a method of compensation, the contract must provide

that the health maintenance organization pay the capitated amount

for an enrollee to an individual dentist licensed under Chapter

256, Occupations Code, that is selected by or assigned to the

enrollee as the enrollee’s primary care dentist.

       SECTION 2.  Section 843.3115(c), Insurance Code, as added by

this Act, applies only to a contract between a health maintenance

organization and a dentist or entity that provides dental care

services entered into on or after the effective date of this Act. A

contract entered into before the effective date of this Act is

governed by the law as it existed immediately before the effective

date of this Act, and that law is continued in effect for that

purpose.

       SECTION 3.  This Act takes effect September 1, 2017.

Comments:  While this bill clarifies capitation payments go to a dentist, section 2 pretty much takes away the bill’s effectiveness as these contracts have been in force for years.  Section 2 needs to be deleted entirely.

Background:  In the current HMO Act law, dentist is not specifically named as a provider while physicians, chiropractors, podiatrists, and etc are named.  Bulk payments many times go to a company name and not a licensed dentist.  Right now due to the ambiguity dentists may or may not be getting paid the capitation payments.  This bill makes it much more difficult to withhold those payments.  Section 2 needs to be deleted!  Let the TDA, your capitation patients, legislators, and your colleagues know that you stand for patient choice!

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Abby Long