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7 LONG TITLE
8 General Description:
9 This bill enacts provisions related to Medicaid reimbursement for dental hygienists.
10 Highlighted Provisions:
11 This bill:
12 ▸ defines terms; and
13 ▸ provides a deadline by which the Department of Health is required to reimburse a
14 dental hygienist directly for services provided through the Medicaid program under
15 certain conditions.
16 Money Appropriated in this Bill:
17 None
18 Other Special Clauses:
19 None
20 Utah Code Sections Affected:
21 AMENDS:
22 26-18-2.6, as last amended by Laws of Utah 2017, Chapter 22
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24 Be it enacted by the Legislature of the state of Utah:
25 Section 1. Section 26-18-2.6 is amended to read:
26 26-18-2.6. Dental benefits -- Contracts with dental plans -- Medicaid
27 reimbursement for dental hygienists.
28 (1) (a) Except as provided in Subsection (8), the division shall establish a competitive
29 bid process to bid out Medicaid dental benefits under this chapter.
30 (b) The division may bid out the Medicaid dental benefits separately from other
31 program benefits.
32 (2) The division shall use the following criteria to evaluate dental bids:
33 (a) ability to manage dental expenses;
34 (b) proven ability to handle dental insurance;
35 (c) efficiency of claim paying procedures;
36 (d) provider contracting, discounts, and adequacy of network; and
37 (e) other criteria established by the department.
38 (3) The division shall request bids for the program's benefits:
39 (a) in 2011; and
40 (b) at least once every five years thereafter.
41 (4) The division's contract with dental plans for the program's benefits shall include
42 risk sharing provisions in which the dental plan must accept 100% of the risk for any difference
43 between the division's premium payments per client and actual dental expenditures.
44 (5) The division may not award contracts to:
45 (a) more than three responsive bidders under this section; or
46 (b) an insurer that does not have a current license in the state.
47 (6) (a) The division may cancel the request for proposals if:
48 (i) there are no responsive bidders; or
49 (ii) the division determines that accepting the bids would increase the program's costs.
50 (b) If the division cancels the request for proposals under Subsection (6)(a), the
51 division shall report to the Health and Human Services Interim Committee regarding the
52 reasons for the decision.
53 (7) Title 63G, Chapter 6a, Utah Procurement Code, shall apply to this section.
54 (8) (a) The division may:
55 (i) establish a dental health care delivery system and payment reform pilot program for
56 Medicaid dental benefits to increase access to cost effective and quality dental health care by
57 increasing the number of dentists available for Medicaid dental services; and
58 (ii) target specific Medicaid populations or geographic areas in the state.
59 (b) The pilot program shall establish compensation models for dentists and dental
60 hygienists that:
61 (i) increase access to quality, cost effective dental care; and
62 (ii) use funds from the Division of Family Health and Preparedness that are available to
63 reimburse dentists for educational loans in exchange for the dentist agreeing to serve Medicaid
64 and under-served populations.
65 (c) The division may amend the state plan and apply to the Secretary of Health and
66 Human Services for waivers or pilot programs if necessary to establish the new dental care
67 delivery and payment reform model. The division shall evaluate the pilot program's effect on
68 the cost of dental care and access to dental care for the targeted Medicaid populations.
69 (9) (a) As used in this Subsection (9), "dental hygienist" means a person who is
70 licensed as a dental hygienist in accordance with Section 58-69-302.
71 (b) Beginning no later than January 1, 2020, the department shall reimburse a dental
72 hygienist directly for a service provided through the Medicaid program if:
73 (i) the dental hygienist requests to be reimbursed directly; and
74 (ii) the dental hygienist provides the service within the scope of practice described in
75 Section 58-69-801.
Legislative Review Note
Office of Legislative Research and General Counsel