1     
DENTAL MANAGED CARE AMENDMENTS

2     
2016 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Allen M. Christensen

5     
House Sponsor: ____________

6     

7     LONG TITLE
8     General Description:
9          This bill requires the use of fee for service reimbursement for Medicaid dental benefits.
10     Highlighted Provisions:
11          This bill:
12          ▸     requires the Division of Health Care Financing to:
13               •     provide Medicaid dental benefits through fee-for-service plans; and
14               •     administer the fee-for-service program; and
15          ▸     repeals the dental health care delivery system and payment reform pilot program.
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 2013, Chapters 278
23     

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.
27          [(1) (a) Except as provided in Subsection (8), the division shall establish a competitive
28     bid process to bid out Medicaid dental benefits under this chapter.]
29          [(b) The division may bid out the Medicaid dental benefits separately from other
30     program benefits.]
31          [(2) The division shall use the following criteria to evaluate dental bids:]
32          [(a) ability to manage dental expenses;]
33          [(b) proven ability to handle dental insurance;]
34          [(c) efficiency of claim paying procedures;]
35          [(d) provider contracting, discounts, and adequacy of network; and]
36          [(e) other criteria established by the department.]
37          [(3) The division shall request bids for the program's benefits:]
38          [(a) in 2011; and]
39          [(b) at least once every five years thereafter.]
40          [(4) The division's contract with dental plans for the program's benefits shall include
41     risk sharing provisions in which the dental plan must accept 100% of the risk for any difference
42     between the division's premium payments per client and actual dental expenditures.]
43          [(5) The division may not award contracts to:]
44          [(a) more than three responsive bidders under this section; or]
45          [(b) an insurer that does not have a current license in the state.]
46          [(6) (a) The division may cancel the request for proposals if:]
47          [(i) there are no responsive bidders; or]
48          [(ii) the division determines that accepting the bids would increase the program's
49     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
63     to reimburse dentists for educational loans in exchange for the dentist agreeing to serve
64     Medicaid 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. The
69     division shall report to the Legislature's Health and Human Services Interim Committee by
70     November 30th of each year that the pilot project is in effect.]
71          (1) The division shall:
72          (a) provide Medicaid dental benefits through fee-for-service reimbursement; and
73          (b) administer the fee-for-service program.
74          (2) The division may not enter into a contract with another entity to administer the
75     fee-for-service program.




Legislative Review Note
Office of Legislative Research and General Counsel