Creating Transparency and Accountability in Dental Services Act; create to require annual reporting., the official text

MISSISSIPPI LEGISLATURE

2026 Regular Session

To: Insurance

By: Representatives Zuber, Felsher, Steverson, Shanks,
McKnight, McLean, McCarty, Owen, Hurst, McMillan, Turner, Bell (65th), Burch,
Ford (73rd), Horan, Varner, Remak, Eure, Hall, Hawkins

House Bill 1117

(As Sent to Governor)

AN ACT TO BE KNOWN AS THE CREATING TRANSPARENCY AND
ACCOUNTABILITY IN DENTAL SERVICES ACT; TO REQUIRE DENTAL INSURANCE CARRIERS TO
PERFORM DENTAL LOSS RATIO CALCULATIONS AND FILE A DENTAL LOSS RATIO ANNUAL
REPORT WITH THE COMMISSIONER OF INSURANCE; TO REQUIRE THE COMMISSIONER TO MAKE
SUCH REPORTS AVAILABLE TO THE PUBLIC ON THE WEBSITE FOR THE DEPARTMENT OF
INSURANCE; TO REQUIRE THE COMMISSIONER TO FILE A REPORT ON THE DATA COLLECTED
PURSUANT TO THE REPORTS SUBMITTED BY CARRIERS WITH BOTH THE SENATE AND HOUSE
INSURANCE COMMITTEES; AND FOR RELATED PURPOSES.

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

SECTION 1.
(1)  This act shall be known and may be cited as the "Creating
Transparency and Accountability in Dental Services Act".  The purpose of
this act is to provide for transparency and accountability of the expenditures
of dental health care service plan premiums and to require annual reporting.

(2)  For the purposes of
this section, the following terms have the meanings as defined in this
subsection, unless the context clearly indicates otherwise:

(a)  "Commissioner"
and "department" refer to the Commissioner of Insurance and the
Department of Insurance respectively.

(b)  "Dental
carrier" or "carrier" means a dental insurance company, dental
service corporation, dental plan organization authorized to provide dental
benefits, or a health insurance plan that includes coverage for dental
services.

(c)  "Dental
health care service plan" or "plan" means any plan that provides
coverage for dental health care services to enrollees in exchange for premiums.

(d)  "Dental loss
ratio" or "DLR" means a percentage of premium dollars spent on
patient care as calculated pursuant to this section.

(3)  Dental loss ratio
calculations are calculated by dividing the numerator by the denominator as
follows:

(a)  The numerator
shall be the amount spent on patient care and shall include:

(i)  The amount
expended for clinical dental services which are services within the code on
dental procedures and nomenclature, provided to enrollees which includes
payments under capitation contracts with dental providers, whose services are
covered by the contract for dental clinical services or supplies covered by the
contract, provided that any overpayment that has already been received from
providers shall not be reported as a paid claim.  Overpayment recoveries
received from providers shall be deducted from incurred claim amounts;

(ii)  Unpaid claim
reserves; and

(iii)  Claim
payments recovered by insurers from providers or enrollees using utilization
management efforts, deducted from claim amounts.

(b)  Calculation of the
numerator shall not include:

(i)  All
administrative costs, including, but not limited to, infrastructure, personnel
costs or broker payments;

(ii)  Amounts paid
to third-party vendors for secondary network savings;

(iii)  Amounts paid
to third-party vendors for network development, administrative fees, claims
processing and utilization management; and

(iv)  Amounts paid
to a provider for professional or administrative services that do not represent
compensation or reimbursement for covered services to an enrollee, including,
but not limited to, dental record copying costs, attorney fees, subrogation
vendor fees, compensation to paraprofessionals, janitors, quality assurance
analysts, administrative supervisors, secretaries to dental personnel and
dental record clerks.

(c)  The denominator is
the total amount of earned premium revenue except for federal and state taxes,
licensing and regulatory fees paid, and any other payments required by federal
law.

(4)  (a)  In order to
provide transparency of patient premium expenditures for dental health care
services, all carriers that renew, deliver or issue a dental health care service
plan in this state shall file a dental loss ratio annual report for the
preceding calendar year with the commissioner no later than June 30, 2026, and
annually thereafter, no later than June 30 of each calendar year.

(b)  The annual report
shall:

(i)  Be organized
by market and product type;

(ii)  Contain the
same information as required by the 2013 federal Centers for Medicare &
Medicaid Services Medical Loss Ratio Annual Reporting Form (CMS-10418); and

(iii)  Provide the
number of enrollees, the plan cost-sharing, deductible amounts, the annual
maximum coverage limit, and the number of enrollees who meet or exceed the
annual coverage limit.

(c)  Any terms used in
the data loss ratio annual report shall have the same meaning as used in the federal
Public Health Service Act, 42 USC Section 300gg-18, and Part 158 of Title 45 of
the Code of Federal Regulations.

(d)  The data loss
ratio annual report filed with the commissioner shall be made available to the
public no later than December 1, 2026, and annually thereafter, no later than
December 1 of each calendar year.  The commissioner shall post the dental loss
ratio in a searchable format on the department's website.

(5)  If the commissioner
deems it necessary that additional information is needed to verify a plan's
representation of its data, the commissioner shall provide a written notice to
the carrier that requests this additional information.  The carrier shall have
thirty (30) days from receipt of the notice to submit the additional information.

(6)  The commissioner shall
file a report on the data collected pursuant to this section with both the
Senate and House Insurance Committees no later than December 1, 2026, and
annually thereafter, no later than December 1 of each subsequent calendar year.

(7)  The provisions of this
section shall not apply to benefit plans under Medicaid, the Mississippi
Children's Health Insurance Program, or other state-sponsored plans.

SECTION 2.  This act
shall take effect and be in force from and after its passage.