UT Code § 31A-22-646.1 (2021)
2021 Utah Code|Title 31A - Insurance Code|Chapter 22 - Contracts in Specific Lines|Part 6 - Accident and Health Insurance|Section 646.1 - Leasing requirements for dental plans.

 Effective 5/5/2021  31A-22-646.1. Leasing requirements for dental plans.    (1) As used in this section:   (a) "Contracting entity" means a person that enters into a direct contract with a provider for the delivery of dental services in the ordinary course of business, including a third party administrator or a dental carrier.     (b) "Dental carrier" means a dental insurance company, dental service corporation, or dental plan organization authorized to provide a dental plan.     (c) "Dental plan" means the same as that term is defined in Section 31A-22-646.     (d)   (i) "Dental services" means services for the diagnosis, prevention, treatment, or cure of a dental condition, illness, injury, or disease.     (ii) "Dental services" does not include services that a provider delivers and bills as medical expenses under a health benefit plan.       (e)   (i) "Dental service contractor" means an individual who:   (A) accepts prepayment for dental services; or     (B) for the benefit of another individual, accepts payment for providing to the individual the opportunity to receive dental services in the future.       (ii) "Dental service contractor" does not include a provider or professional dental corporation that accepts prepayment on a fee-for-service basis for providing specific dental services to individual patients for whom the services have been pre-diagnosed.       (f)   (i) "Provider" means a person who, acting within the scope of licensure or certification, provides dental services or supplies defined by the dental plan.     (ii) "Provider" does not include a physician organization or physician hospital organization that leases or rents the physician organization's or physician hospital organization's network to a third party.       (g) "Provider network contract" means a contract between a contracting entity and a provider that:   (i) specifies the rights and responsibilities of the contracting entity; and     (ii) provides for the delivery and payment of dental services to an enrollee.       (h)   (i) "Third party" means a person that enters into a contract with a contracting entity or with another third party to gain access to the dental services or contractual discounts of a provider network contract.     (ii) "Third party" does not include an employer or other group for whom the dental carrier or contracting entity provides administrative services.         (2) A contracting entity may grant a third party access to a provider network contract regarding dental services, including a provider's dental services, or a contractual discount provided under a provider network contract for dental services if:   (a) if the contracting entity is an insurer, the insurer complies with Subsection (3);     (b) the contract between the contracting entity and a person subject to the third-party access complies with Subsection (4); and     (c) the contracting entity complies with Subsection (5).       (3) An insurer shall:   (a) at the time a contract is entered into or renewed, or when there is a material modification to a contract that is relevant to third-party access to a provider network contract, allow a provider which is part of the insurer's provider network to:   (i) choose to not participate in third-party access; or     (ii) enter into a contract directly with the third party that acquired the provider network;       (b) allow a provider to opt out of lease arrangements without canceling or ending a contractual relationship with the insurer; and     (c) when initially contracting with a provider, accept a qualified provider even if a provider rejects a network lease provision.       (4) A contracting entity described in Subsection (2) shall ensure that the contract described in Subsection (2)(b) includes the following:   (a) a provision indicating the contracting entity may enter into an agreement with a third party to allow the third party to obtain the contracting entity's rights and responsibilities as if the third party were the contracting entity;     (b) if the contracting entity is a dental carrier, a provision indicating that the provider chose to participate in third-party access at the time the provider network contract was entered into or renewed; and     (c) if the contracting entity is an insurer, a provision indicating:   (i) that the contract grants a third party access to the provider network; and     (ii) for a contract with a dental carrier, the dentist has the right to choose not to participate in third-party access.         (5) A contracting entity shall:   (a) provide a provider, in writing or electronic form, each third party in existence as of the date the contract is entered into;     (b) maintain a list of each third party in existence on the contracting entity's website that is updated at least once every 90 days;     (c) require a third party to identify the source of the discount on all remittance advices or explanations of payment under which a discount is taken unless the transaction is an electronic transaction mandated by the Health Insurance Portability and Accountability Act;     (d) notify a third party of the termination of a provider network contract no later than 30 days after the day on which the contract terminates with the contracting entity;     (e) at least 30 days before the day on which a third party begins leasing a network provider, notify each network provider subject to the lease;     (f) make available to a participating provider, within 30 days after the day on which the provider makes a request, a copy of the provider network contract at issue in the adjudication of a claim; and     (g) maintain a list of the contracting entity's affiliates on the contracting entity's website.       (6) A third party that gains access to a contract under this section:   (a) shall comply with each term of the contract to which the third party gains access; and     (b) loses all rights to a provider's discounted rate as of the termination date of the provider network contract.       (7) A contracting entity or third party may not require a provider to perform services under a provider network contract if a third party gains access to a contract in violation of this section.     (8) This section does not apply to:   (a) a contracting entity granting access to a provider network contract to:   (i) an entity that operates in accordance with the brand licensee program of the contracting entity; or     (ii) an entity that is an affiliate of the contracting entity; and       (b) a provider network contract for dental services provided to beneficiaries of a state sponsored health program, including Medicaid and the Children's Health Insurance Program.       (9) A contract executed or renewed on or after January 1, 2022:   (a) may not waive the provisions of this section; and     (b) is null and void if the contract contains provisions that conflict with the provisions of this section or that purports to waive a requirement of this section.      Enacted by Chapter 288, 2021 General Session