00 HOUSE BILL NO. 273 01 "An Act relating to direct health care agreements; relating to dental health care 02 insurance plans and dental loss ratios; and providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04  * Section 1. AS 21.03.025(a) is amended to read: 05 (a) A health care provider or health care business and a patient or the 06 representative of a patient may enter into a direct health care agreement. The 07 [HEALTH CARE] services provided under a direct health care agreement are limited 08 to dental care services and the type of health care services that a primary care 09 provider may provide to a patient. A patient is not eligible to enter into a direct health 10 care agreement under this section if the patient is eligible to receive assistance under 11 AS 47.07 (Medical Assistance for Needy Persons) or AS 47.08 (Assistance for 12 Catastrophic Illness and Chronic or Acute Medical Conditions). 13  * Sec. 2. AS 21.03.025(c) is amended to read: 14 (c) A direct health care agreement must 01 (1) describe the dental care services or health care services that the 02 health care provider or health care business makes available to the patient in exchange 03 for payment of a periodic fee and each location at which the dental care services or 04 health care services are available; 05 (2) specify 06 (A) the amount of the periodic fee a patient or the 07 representative of a patient pays in exchange for the dental care services or  08 health care services that the health care provider or health care business makes 09 available to the patient; 10 (B) the period covered by the periodic fee under (A) of this 11 paragraph; and 12 (C) additional fees that the health care provider or health care 13 business may charge in addition to the periodic fee, including cancellation 14 fees; 15 (3) identify and include contact information for a representative of the 16 health care provider or health care business that is responsible for receiving and 17 addressing 18 (A) a complaint made by a patient relating to the agreement; 19 and 20 (B) a request made by a patient to amend the agreement, 21 including a patient's request to change the name of the representative of the 22 patient or the patient's mailing address, physical address, telephone number, 23 electronic mail address, or other personal information; 24 (4) prominently state that the patient is not entitled to the protections 25 under AS 21.07 (Patient Protections Under Health Care Insurance Policies and Prior 26 Authorizations). 27  * Sec. 3. AS 21.03.025(m) is amended to read: 28 (m) A direct health care agreement and a health care provider or health care 29 business providing dental care services or health care services under a direct health 30 care agreement are subject to AS 21.36 (Trade Practices and Frauds) to the extent 31 applicable and when not in conflict with the express provisions of this section. 01  * Sec. 4. AS 21.03.025(o) is amended to read: 02 (o) A health care provider or health care business may decline to enter into a 03 direct health care agreement with a new patient if the health care provider or health 04 care business 05 (1) is unable to provide to the patient the dental care services or 06 health care services the patient requires; or 07 (2) does not have the capacity to accept new patients. 08  * Sec. 5. AS 21.03.025(p) is amended to read: 09 (p) A health care provider or health care business may terminate a direct 10 health care agreement with an existing patient based on the patient's health status only 11 if the health care provider is unable to provide to the patient the dental care services  12 or health care services the patient requires or in accordance with this section. 13  * Sec. 6. AS 21.03.025(r)(1) is amended to read: 14 (1) "direct health care agreement" means a written agreement between 15 a health care provider or health care business and a patient or the representative of a 16 patient to provide dental care services or health care services in exchange for 17 payment of a periodic fee; 18  * Sec. 7. AS 21.96 is amended by adding new sections to read: 19 Sec. 21.96.210. Dental loss ratio report. (a) An insurer that offers, issues for 20 delivery, delivers, or renews in this state a specialized dental health care service plan 21 shall annually file a dental loss ratio report with the director that is organized by 22 market and product type, contains the same information required in the federal Centers 23 for Medicare and Medicaid Services medical loss ratio annual reporting form for the 24 2013 medical loss ratio reporting year, and includes the number of enrollees, the plan 25 cost-sharing and deductible amounts, the annual maximum coverage limit, and the 26 number of enrollees who meet or exceed the annual coverage limit. The report must 27 contain information for the most recent complete fiscal year during which the plan 28 provided dental coverage. 29 (b) All terms used in the dental loss ratio report must have the same meaning 30 as the terms used in 42 U.S.C. 300gg-18 and supporting federal regulations. 31 (c) If the director considers it necessary to verify the data of the insurer in the 01 dental loss ratio report, the director shall notify the insurer and allow the insurer 30 02 days to submit any requested information. 03 (d) By January 1 of the year after the director receives the dental loss ratio 04 report, the director shall make the information, including the aggregate dental loss 05 ratio and other data reported under this section, available to the public in a searchable 06 format that allows members of the public to compare dental loss ratios among carriers 07 by plan type by posting the information on the division's Internet website or providing 08 the information to the administrator of an all-payer health claims database. If the 09 director provides the information to the administrator, the administrator shall make the 10 information available to the public in a format determined by the director. 11 (e) The director shall file a report with the data collected under this section 12 with the senate secretary and the chief clerk of the house of representatives and notify 13 the legislature that the report is available. The report must list plans identified as 14 outliers under AS 21.96.215(b), and show changes from year to year in the status of 15 insurers' plans relative to meeting the standard in AS 21.96.215(b). 16 (f) In this section, the percentage of premium dollars spent on patient care is 17 calculated by dividing the numerator by the denominator, where 18 (1) the numerator is the sum of the amount incurred for clinical dental 19 services provided to enrollees, the amount incurred on activities that improve dental 20 care quality as defined by the commissioner in regulation not to exceed five percent of 21 net premium revenue, and other incurred claims as defined in 45 C.F.R. 158.140(a); 22 overhead and administrative costs, as defined by the commissioner in regulation, may 23 not be included in the numerator; and 24 (2) the denominator is the total amount of premium revenue, excluding 25 federal and state taxes, licensing and regulatory fees paid, nonprofit community 26 benefit expenditures as defined in 45 C.F.R. 158.162(c), and other payments required 27 by federal law. 28 (g) In this section, 29 (1) "dental health care service plan" means a plan that provides 30 coverage for dental health care services to enrollees in exchange for premiums; "dental 31 health care service plan" does not include Medicaid or Children's Health Insurance 01 Program plans; 02 (2) "dental loss ratio" means the percentage of premium dollars spent 03 on patient care, as calculated under (e) of this section; 04 (3) "insurer" means a dental insurance company, dental service 05 corporation, dental plan organization authorized to provide dental benefits, or a health 06 benefits plan that includes coverage for dental services. 07 Sec. 21.96.215. Outliers and remediation. (a) The director shall aggregate the 08 dental loss ratios for each insurer by year using the data provided under AS 21.96.210 09 for each market segment in which the insurer operates. The director shall calculate an 10 average dental loss ratio for each market segment using aggregate data for a three-year 11 period, including data for the most recent dental loss ratio reporting year and the data 12 for the previous two dental loss ratio reporting years. If 50 percent or more of the total 13 earned premium during a reporting year is attributable to policies newly issued in that 14 reporting year, the director may exclude the experience of these policies in calculating 15 an insurer's aggregate dental loss ratio for that reporting year. The director shall add 16 the excluded experience to the experience reported in the following reporting year. 17 (b) The director shall identify as outliers dental health care service plans that 18 fall outside one standard deviation of the average dental loss ratio for that market 19 segment. An insurer is not an outlier under this subsection if the dental loss ratio in a 20 market segment is within three percentage points of the average dental loss ratio. A 21 higher threshold may be set by the director as determined reasonable by the director. 22 (c) The director shall investigate an insurer that reports a dental loss ratio 23 lower than one standard deviation from the mathematical average and may take 24 remediation or enforcement actions against the insurer, including ordering the insurer 25 to rebate, consistent with federal law, premiums paid above amounts that would have 26 caused the insurer to have achieved the mathematical average of the data submitted in 27 a given year for a given market segment. 28 (d) If the dental loss ratio for an insurer in a market segment does not increase 29 and remains an outlier under (b) of this section after two consecutive years, the 30 director shall, except under reasonable circumstances as determined by the director, 31 subject the insurer to a minimum dental loss ratio percentage by market segment. The 01 director shall adopt regulations establishing the dental loss ratio percentage based on, 02 at minimum, the average of existing insurer loss ratios by market segment in the state 03 effective not earlier than 42 months after the insurer is determined to be an outlier 04 under this section. 05 (e) An insurer subject to remediation under (c) or (d) of this section shall 06 provide a rebate owed to a policyholder as required by the director. The director may 07 establish alternatives to providing rebates, including premium reductions in the 08 following benefit year. 09 (f) The director may adopt regulations to create a process to identify insurers 10 that increase rates more than the percentage increase of the latest dental services 11 Consumer Price Index for all urban consumers for urban Alaska as reported by the 12 United States Bureau of Labor Statistics. 13 (g) In this section, 14 (1) "dental health care service plan" has the meaning given in 15 AS 21.96.210; 16 (2) "dental loss ratio" has the meaning given in AS 21.96.210; 17 (3) "insurer" has the meaning given in AS 21.96.210. 18  * Sec. 8. This Act takes effect January 1, 2027.