HB 2558 Dental Capitation Payments: Comments and Background
By: OliversonH.B. No. 2558
A BILL TO BE ENTITLED
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
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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