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7 LONG TITLE
8 General Description:
9 This bill amends the Medical Assistance Act of the Health Code to establish a pilot
10 program for dental health care benefits in the state Medicaid program.
11 Highlighted Provisions:
12 This bill:
13 . authorizes the state Medicaid plan to pilot dental health care payment and delivery
14 reform models;
15 . establishes some criteria for the dental health care pilot project;
16 . requires the Medicaid program to evaluate cost and access to dental care in the pilot
17 program; and
18 . requires the Medicaid program to report to the Legislature regarding the evaluation
19 of the dental health care pilot program.
20 Money Appropriated in this Bill:
22 Other Special Clauses:
24 Utah Code Sections Affected:
26 26-18-2.6, as enacted by Laws of Utah 2011, Chapter 344
28 Be it enacted by the Legislature of the state of Utah:
29 Section 1. Section 26-18-2.6 is amended to read:
30 26-18-2.6. Dental benefits.
31 (1) (a) [
32 competitive bid process to bid out Medicaid dental benefits under this chapter.
33 (b) The division may bid out the Medicaid dental benefits separately from other
34 program benefits.
35 (2) The division shall use the following criteria to evaluate dental bids:
36 (a) ability to manage dental expenses;
37 (b) proven ability to handle dental insurance;
38 (c) efficiency of claim paying procedures;
39 (d) provider contracting, discounts, and adequacy of network; and
40 (e) other criteria established by the department.
41 (3) The division shall request bids for the program's benefits:
42 (a) in 2011; and
43 (b) at least once every five years thereafter.
44 (4) The division's contract with dental plans for the program's benefits shall include
45 risk sharing provisions in which the dental plan must accept 100% of the risk for any difference
46 between the division's premium payments per client and actual dental expenditures.
47 (5) The division may not award contracts to:
48 (a) more than three responsive bidders under this section; or
49 (b) an insurer that does not have a current license in the state.
50 (6) (a) The division may cancel the request for proposals if:
51 (i) there are no responsive bidders; or
52 (ii) the division determines that accepting the bids would increase the program's costs.
53 (b) If the division cancels the request for proposals under Subsection (6)(a), the
54 division shall report to the Health and Human Services Committee regarding the reasons for
55 the decision.
56 (7) Title 63G, Chapter 6, Utah Procurement Code, shall apply to this section.
57 (8) (a) The division may:
58 (i) establish a dental health care delivery system and payment reform pilot program for
59 Medicaid dental benefits to increase access to cost effective and quality dental health care by
60 increasing the number of dentists available for Medicaid dental services; and
61 (ii) target specific Medicaid populations or geographic areas in the state.
62 (b) The pilot program shall establish compensation models for dentists and dental
63 hygienists that:
64 (i) increase access to quality, cost effective dental care; and
65 (ii) use the state's primary care grants to reimburse dentists for educational loans in
66 exchange for the dentist agreeing to serve Medicaid and under-served populations.
67 (c) The division may amend the state plan and apply to the Secretary of Health and
68 Human Services for waivers or pilot programs if necessary to establish the new dental care
69 delivery and payment reform model. The division shall evaluate the pilot program's effect on
70 the cost of dental care and access to dental care for the targeted Medicaid populations. The
71 division shall report to the Legislature's Health and Human Services Interim Committee by
72 November 30th of each year that the pilot project is in effect.
Legislative Review Note
as of 1-30-12 5:58 PM