HOUSE BILL REPORT

SHB 2229

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Amended by the Senate

Title: An act relating to the applicability of dental practice laws to integrated care delivery systems.

Brief Description: Concerning the applicability of dental practice laws to integrated care delivery systems.

Sponsors: House Committee on Health Care & Wellness (originally sponsored by Representative Macri).

Brief History:

Committee Activity:

Health Care & Wellness: 1/30/18, 1/31/18 [DPS].

Floor Activity:

Passed House: 2/12/18, 98-0.

Senate Amended.

Passed Senate: 2/27/18, 49-0.

Brief Summary of Substitute Bill

  • Exempts licensed health care service contractors that are organized as nonprofit integrated care delivery systems from provisions that prohibit corporations from practicing dentistry or from soliciting dental patronage for dentists employed by a corporation.

HOUSE COMMITTEE ON HEALTH CARE & WELLNESS

Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. Signed by 16 members: Representatives Cody, Chair; Macri, Vice Chair; Schmick, Ranking Minority Member; Graves, Assistant Ranking Minority Member; Caldier, Clibborn, DeBolt, Harris, Jinkins, MacEwen, Maycumber, Riccelli, Robinson, Slatter, Stonier and Tharinger.

Staff: Kim Weidenaar (786-7120).

Background:

Practice of Dentistry.

Dentists are licensed and regulated by the Dental Quality Assurance Commission (Commission). No person may practice dentistry without first obtaining a license. The practice of dentistry is defined as:

Corporations are prohibited from practicing dentistry or soliciting dental patronage for dentists employed by a corporation. However, a person or entity not licensed by the Commission may:

Uniform Disciplinary Act.

A person not licensed as a dentist, or an entity that is not a professional entity, practices dentistry in violation of the law and is subject to enforcement under the Uniform Disciplinary Act (UDA) if it interferes with a dentist's independent clinical judgment by:

Under the UDA, the Secretary of Health investigates complaints regarding unlicensed practice and may issue a cease and desist order and impose a fine of up to $1,000 per day. Unlicensed practice is also a gross misdemeanor for the first violation and a class C felony for subsequent violations.

Health Care Service Contractor.

A health care service contractor is an entity that accepts prepayment for health care services from, or for the benefit of, enrollees as consideration for providing the enrollees with health care services. A health care service contractor offering coverage to individuals or small groups is required, under the federal Patient Protection and Affordable Care Act, to cover 10 categories of essential health benefits. A health care service contractor is defined as any corporation, cooperative group, or association, which is sponsored by or otherwise intimately connected with a provider or group of providers, who or which, not otherwise being engaged in the insurance business, accepts prepayment for health care services from or for the benefit of persons or groups of persons as consideration for providing such persons with any health care services. It does not include direct patient-provider primary care practices, which provide patients all primary care services provided in the health care practitioners office for a set fee, regardless of the number of visits. Patients pay a monthly fee directly outside of any insurance the individual may have.

Anti-kickback Statute.

Federal law known as the anti-kickback statute provides criminal penalties for individuals or entities that knowingly and willingly offer, pay, solicit, or receive remuneration in order to induce or reward the referral of business that is reimbursable under any federal health care programs. The types of remuneration specifically prohibited include kickbacks, bribes, and rebates made in cash or in kind.

Anti-kickback Safe Harbors.

Subsequent legislation established safe-harbor protections for certain payment practices and business arrangements that would otherwise be considered suspect under the statute. If all the conditions of the safe harbor are met, the practices are not subject to criminal prosecution.

The personal services and management contracts safe harbor requires that seven standards are met:

The price reductions offered to eligible managed care organizations (MCO) safe harbor provides for several arrangements:

A first tier contractor is an individual or entity that has a contract directly with an eligible MCO. A downstream contractor is an individual or entity that has a subcontract directly or indirectly with a first tier contractor to provide items or services that are covered by an agreement between an eligible MCO and first tier contractor.

The space rental and equipment rental safe harbors require the same six standards:

Summary of Substitute Bill:

In order to be exempted from the prohibitions on the corporate practice of dentistry and solicitation of dental patronage for dentists employed by a corporation, an arrangement for care delivery between a licensed health service contractor organized as a nonprofit integrated care delivery system and a health care provider, the arrangement between the parties must meet the requirements of following anti-kickback statute safe harbors:

These entities are still subject to other limits on unlicensed individuals or corporations including the prohibitions on interfering with a dentist's clinical judgement.

EFFECT OF SENATE AMENDMENT(S):

The Senate amendment: removes the exemption from the prohibition on the corporate practice of medicine for an arrangement between a health care service contractor organized as a nonprofit integrated care delivery system and a health care provider if certain requirements are met; replaces that exemption with a specific allowance for a health care service contractor organized as a nonprofit integrated care delivery system to contract for the services of licensed dentists, and employ or contract for the services of licensed dental hygienists, licensed expanded function dental auxiliaries, certified dental anesthesia assistants, and registered dental assistants if certain requirements are met; and provides that the act does not prohibit health carriers from entering into provider contracts or provider compensation agreements with a dentist or dental practice.

Appropriation: None.

Fiscal Note: Not requested.

Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.

Staff Summary of Public Testimony:

(In support) A bill on the corporate practice of dentistry passed last year, however, it did not consider the impacts on Kaiser, which has a long standing integrated dental practice. Kaiser has an exclusive partnership with a dentist-owned organization, but ambiguity in the previous bill threatened its existence. During the interim stakeholders worked together to come to an agreement that will ensure that Kaiser's integrated dental practice can continue while also safeguarding patients. This bill will eliminate the statutory ambiguity and will allow Kaiser to continue to operate its integrated dental services.

(Opposed) None.

Persons Testifying: Representative Macri, prime sponsor; Steve Bush, Kaiser Permanente Dental; and Mellani McAleenan, Washington State Dental Association.

Persons Signed In To Testify But Not Testifying: None.