1     
MEDICAID DENTAL BENEFITS

2     
2018 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Steve Eliason

5     
Senate Sponsor: Peter C. Knudson

6     

7     LONG TITLE
8     General Description:
9          This bill addresses dental benefits in the Medicaid program.
10     Highlighted Provisions:
11          This bill:
12          ▸     provides dental benefits to certain adults in the Medicaid program.
13     Money Appropriated in this Bill:
14          None
15     Other Special Clauses:
16          None
17     Utah Code Sections Affected:
18     AMENDS:
19          26-18-413, as last amended by Laws of Utah 2017, Chapter 233
20     

21     Be it enacted by the Legislature of the state of Utah:
22          Section 1. Section 26-18-413 is amended to read:
23          26-18-413. Medicaid waiver for delivery of adult dental services.
24          (1) (a) [No later than] Before June 30, 2016, the department shall ask the United States
25     Secretary of Health and Human Services to grant waivers from federal statutory and regulatory
26     law necessary for the Medicaid program to provide dental services in the manner described in
27     Subsection (2).
28          (b) Before June 30, 2018, the department shall submit to the Centers for Medicare and
29     Medicaid Services a request for waivers, or an amendment of existing waivers, from federal
30     law necessary for the state to provide dental services, in accordance with Subsections (2)(b)
31     through (g), to an individual described in Subsection (2)(b).
32          (2) (a) To the extent funded, [services shall be provided] the department shall provide
33     services to only blind or disabled individuals, as defined in 42 U.S.C. Sec. 1382c(a)(1), who
34     are 18 years [of age] old or older and eligible for the program.
35          (b) Notwithstanding Subsection (2)(a), if a waiver is approved under Subsection (1)(b),
36     the department shall provide dental services to an individual who:
37          (i) qualifies for the health coverage improvement program described in Section
38     26-18-411; and
39          (ii) is receiving treatment in a substance abuse treatment program, as defined in Section
40     62A-2-101, licensed under Title 62A, Chapter 2, Licensure of Programs and Facilities.
41          [(b)] (c) To the extent possible, services to individuals described in Subsection (2)(a)
42     within Salt Lake County shall be provided through the University of Utah School of Dentistry.
43          (d) The department shall provide the services to individuals described in Subsection
44     (2)(b):
45          (i) by contracting with an entity that:
46          (A) has demonstrated experience working with individuals who are being treated for
47     both a substance use disorder and a major oral health disease;
48          (B) operates a program, targeted at the individuals described in Subsection (2)(b), that
49     has demonstrated, through a peer-reviewed evaluation, the effectiveness of providing dental
50     treatment to those individuals described in Subsection (2)(b);
51          (C) is willing to pay for an amount equal to the program's non-federal share of the cost
52     of providing dental services to the population described in Subsection (2)(b); and
53          (D) is willing to pay all state costs associated with applying for the waiver described in
54     Subsection (1)(b) and administering the program described in Subsection (2)(b); and
55          (ii) through a fee-for-service payment model.
56          (e) The entity that receives the contract under Subsection (2)(d)(i) shall cover all state
57     costs of the program described in Subsection (2)(b).
58          [(c)] (f) Each fiscal year, the University of Utah School of Dentistry shall transfer
59     money to the program in an amount equal to the program's non-federal share of the cost of
60     providing services under this section through the school during the fiscal year.
61          [(d)] (g) During each general session of the Legislature, the department shall report to
62     the Social Services Appropriations Subcommittee whether the University of Utah School of
63     Dentistry will have sufficient funds to make the transfer required by Subsection (2)[(c)](f) for
64     the current fiscal year.
65          [(e)] (h) Where possible, the department shall ensure that services that are not provided
66     by the University of Utah School of Dentistry [shall be] are provided:
67          (i) through fee for service reimbursement until July 1, 2018; and
68          (ii) after July 1, 2018, through the method of reimbursement used by the division for
69     Medicaid dental benefits.
70          [(f)] (i) Subject to appropriations by the Legislature, and as determined by the
71     department, the scope, amount, duration, and frequency of services may be limited.
72          (3) The reporting requirements of Section 26-18-3 apply to the waivers requested under
73     Subsection (1).
74          (4) (a) If the waivers requested under Subsection (1)(a) are granted, the Medicaid
75     program shall begin providing dental services in the manner described in Subsection (2) no
76     later than July 1, 2017.
77          (b) If the waivers requested under Subsection (1)(b) are granted, the Medicaid program
78     shall begin providing dental services to the population described in Subsection (2)(b) within 90
79     days from the day on which the waivers are granted.
80          (5) If the federal share of the cost of providing dental services under this section will be
81     less than 65% during any portion of the next fiscal year, the Medicaid program shall cease
82     providing dental services under this section [indefinitely] no later than the end of the current
83     fiscal year.