Report Title:

Dentists Reimbursement; Usual, Customary, and Reasonable Fee

 

Description:

Requires rates of payment to dentists to be based on the 75th percentile of the usual, customary, and reasonable fee established by insurers for services provided by dentists.  Defines the term "usual, customary, and reasonable fee."  (HB2315 HD1)

 

HOUSE OF REPRESENTATIVES

H.B. NO.

2315

TWENTY-FOURTH LEGISLATURE, 2008

H.D. 1

STATE OF HAWAII

 

 

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO DENTISTS.

 

 

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

 

     SECTION 1.  Section 346-59, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

     "(b)  Rates of payment to providers of medical care who are individual practitioners, including doctors of medicine, [dentists,] podiatrists, psychologists, osteopaths, optometrists, and other individuals providing services, shall be based upon the Hawaii medicaid fee schedule[.]; provided that rates of payment to dentists shall be based on the seventy-fifth percentile of the usual, customary, and reasonable fee established by insurers for services provided by dentists.  [The] Except for payments to dentists, the amounts paid shall not exceed the maximum permitted to be paid individual practitioners or other individuals under federal law and regulation, the medicare fee schedule for the current year, the state limits as provided in the appropriation act, or the provider's billed amount.

     The appropriation act shall indicate the percentage of the medicare fee schedule for the year 2000 to be used as the basis for establishing the Hawaii medicaid fee schedule.  For any subsequent adjustments to the fee schedule, the legislature shall specify the extent of the adjustment in the appropriation act.

     As used in this subsection:

     "Customary fee" means the fee determined from actual fees submitted for a specific dental procedure.  The customary fee establishes the maximum benefit payable for that procedure.

     "Reasonable fee" means the fee charged by a dentist for a specific dental procedure that has been modified by complications or unusual circumstances.

     "Usual fee" means the fee that an individual dentist most frequently charges for a specific dental procedure."

     SECTION 2.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 3.  This Act shall take effect on January 1, 2050.