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H.B. 125





Chief Sponsor: Tim M. Cosgrove

Senate Sponsor: Peter C. Knudson

             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:
             21          None
             22      Other Special Clauses:
             23          None
             24      Utah Code Sections Affected:
             25      AMENDS:
             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) [The] Except as provided in Subsection (8), the division shall establish 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

Office of Legislative Research and General Counsel

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